Jesus League Special Needs VBS Registration Form 2019
We so excited summer is here, which means VBS fun! Parents and guardians please take a few minute to fill out this form so can create the best environment for our friends. Complete the form by June 22, 2018 and be entered to win a $50 visa gift card!!!!
Email address *
Child/Adult Names *
Your answer
Birthday *
MM
/
DD
/
YYYY
Address *
Your answer
Phone Number *
Your answer
Parent(s)/Guardian(s) Name(s) *
Your answer
Child/Adult Basic Information
Allergies or Food Restrictions *
Your answer
Can your child/adult have Charlie's Snowballs *
Diagnosis:
Your answer
Hygiene(bathroom) Capabilities *
Your answer
Behavioral Support Needs
Your answer
What make child/adult uncomfortable
Your answer
What makes child/adult comfortable
Your answer
List below an emergency contact if parents/guardian cannot be reached. *
Your answer
Additional Helpful Hints
Your answer
Declaration of Consent
I give First Christian Church of Kilgore permission to use my child's picture in presentation, church publication, church website, and social media. *
I agree to release First Christian Church of Kilgore and all staff and volunteers from all liability for any additional illness or injury to my child, and for any accidental damage or destruction of my child's property during an activity at the church. *
I give First Christian Church a medical release to provide medical care deemed needed in event I am not available. *
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