VBS: Wild Life - September 2023
Second Congregational Church
September 25, 2023

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Child's Name *
Nickname (Optional)
M/F *
Birthdate *
School Currently Attending *
Grade Fall 2023 *
If siblings attending please list each sibling below
Parent/Guardian Name *
Street Address *
City *
State *
Zip Code *
Parent/Guardian Cell Phone *
Parent/Guardian Email *
Emergency Contact Name *
Emergency Contact Cell Phone *
Emergency Contact Relationship to Registrant *
Is your child allergic to any food/medication? *
If allergic, please explain below
I give permission for my child to be photographed during VBS on September 25, 2023. I understand that the photos may be used to keep a journal of activities and/or to share on Second Congregational social media channels but my child's identity will not be disclosed. *
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