Preschool VBS 2019
Complete form to register each child for 2019 Preschool VBS
June 11-14, 2019 9:00 -11:00 AM
Trinity Evangelical UMC
108 Malabar Dr Upper Sandusky OH 43351
West End
Contact Jen Homburg jen@mytrinity.us or Jenny Eyer-Kerr at jenny@mytrinity.us
(419) 294-1535
Child Information
Please complete the following information for each child attending Preschool VBS 2019
Child Last Name *
Your answer
Child First Name *
Your answer
Best Contact Email to share information about VBS *
Your answer
Street/Mailing Address *
Your answer
City State Zip
Your answer
Gender *
Birth Date *
MM
/
DD
/
YYYY
My child will be ____ age at the time of VBS 2019 June 11-14 *
We ask that all participants are potty trained. Is the registered child potty trained? *
Please list any allergies, medical conditions, and/or physical limitations for the child. *
Your answer
My child can have cookie snack and water during VBS.
Will your child bring medications, with him/her including Epi Pen or inhaler? *
Request to be in same group with another child? Please indicate child's name or simply type none. We will do our best to accommodate this request *
Your answer
Request to be in the same group with specific leader? Please indicate leader's name or simply type none. We will do our best to accommodate this request *
Your answer
Parent/Guardian Information
Parent/Guardian Name #1 *
Your answer
Parent/Guardian #1 Contact Number During Event *
Your answer
Parent/Guardian #1 Address If Different
Your answer
Parent/Guardian Name #2
Your answer
Parent/Guardian #2 Contact Number During Event
Your answer
Parent/Guardian #2 Address If Different
Your answer
Emergency Contact Information
Please identify who we should contact in the event the parent is not reachable
Emergency Contact #1 Name *
Your answer
Emergency Contact #1 Relationship *
Your answer
Emergency Contact #1 Contact Number *
Your answer
Emergency Contact #2 Name
Your answer
Emergency Contact #2 Relationship
Your answer
Emergency Contact #2 Contact Number
Your answer
List people authorized to pick up child including Parents/Guardians and Emergency Contact People listed above. *
Your answer
Pick Up Procedure - I understand that all authorized pick up people will be asked to show ID at the time of pick up daily and have informed pick up people of this expectation for a smooth and safe transition. Thanks for your support! *
Permissions
Permission - I give permission for my child to participate in the VBS program at Trinity Evangelical UMC. I here by voluntarily assume all risk of accident and injury to my child which may arise from his/her participation in this event, completely releasing Trinity Evangelical UMC and all personnel associated with the event form liability that may result from his/her participation. *
Text - I give Trinity Evangelical and Sonlight Children’s Ministry permission to add my phone number to their Text Signal program and agree to receive texts from them. *
Photos/Digital Images - I give Trinity Evangelical and Sonlight Children’s Ministry my permission for my child’s picture to be taken and used for church promotion such as during services, on church displays and publications like bulletin/ newsletter, and church website and Facebook page. *
Medical Treatment – In the event that I, the undersigned cannot be reached in an emergency, I hereby give my permission to the physician, dentist, or hospital selected by the staff to secure proper medical or dental treatment for my child named above. I agree to be liable and pay all costs and expenses incurred in connection with such medical and dental services rendered. *
PARENTS/GUARDIANS - If you acknowledge and agree that all the information above is correct and you have given your child permission to attend the 2018 Preschool VBS Sonlight Children’s Ministry please type your name below. Your typed named below will be a symbol of your signature for this agreement. *
Your answer
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