VBS: Wild Life - September 2023

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Second Congregational Church
September 25, 2023

Child's Name *

Nickname (Optional)

M/F *

Male

Female

Birthdate *

YYYY

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? *

Yes

Required

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. *

Yes

Required

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