St. Aidan's Episcopal Church - Vacation Bible School Registration
Register here for Rolling River Rampage Vacation Bible School, August 6-9, 2018. Each evening begins with dinner served at 5:30 p.m., and program is 6 to 8 p.m.
Email address *
Student's name *
Your answer
Student's age *
Your answer
Last grade completed *
Your answer
Parent/guardian name *
Your answer
Address *
Your answer
City *
Your answer
Zip code *
Your answer
Home phone *
Your answer
Work phone
Your answer
Cell phone *
Your answer
Name of emergency contact in case parent cannot be reached *
Your answer
Emergency contact phone number *
Your answer
Does the student have any allergies or medical concerns? *
Your answer
Medical insurance company name *
Your answer
Medical insurance policy number *
Your answer
As the parent or legal guardian, do you hereby grant to the adult supervisors and leaders of St. Aidan’s Episcopal Church to make medical decisions with respect to said minor child in the event of an accident or injury when parental consent shall be unavailable or when circumstances shall require immediate medical decision, and to administer medication when required? *
Required
I grant permission for my child to appear in photos or video recorded by St. Aidan's Episcopal Church during Vacation Bible School and for these photos to be used on their website and Facebook page. *
Required
Enter your name here to sign this form (required) *
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Today's date *
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Please name all persons authorized to pick-up this student from VBS each evening (Student will not be allowed to leave with anyone not on this list.): *
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A copy of your responses will be emailed to the address you provided.
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