VBS Registration Form

 

REGISTRATION FORM

CAMP OUT!!    VBS

June 2017

One form per child, please.

 

Child’s name: _________________________________________________________________________________

Grade completed ____________ Birthdate ___________________ Age ___________

Parents’ names: _______________________________________________________________________________

Home Address:  _______________________________________________________________________________

Home phone ___________________________________________

Alternate phone(s)_______________________________________

 

 

EMERGENCY CONTACT PERSON:  (If parent is unavailable)  _____________________________________________

Relationship to student: _________________________________________________________________________

Emergency Contact Person Phone ________________________________________

Alternate phone(s) ____________________________________________________

 

 

CHILD INFORMATION:

 

Food allergies:   (Please circle)        Yes____No__(List:) _________________________________________________

 

Permission to administer simple first aid (i.e., bandaids)   Yes       No   (Please initial) _________________________

 

Medical concerns/conditions:    Yes       No     Explain: _________________________________________________

 

Family doctor __________________________________________ Doctor’s phone __________________________

 

Siblings attending VBS (names and ages) ____________________________________________________________

 

Custody Orders    Yes   or  No    Please indicate who may not pick up any child.______________________________

 

***************                           *****************                ****************                       ***************

 

People who may pick up the child/children other than the legal parent/guardian:  (List name and relationship to child/children).  Indicate if this will be on a daily basis.

_____________________________________________________________________________________________

_____________________________________________________________________________________________

 

VBS leaders have permission to photograph/film the minor(s) designated above in any manner or form

for any lawful purpose associated with this VBS program.

 

Parent’s signature: ___________________________________________________________________________

 

 

REGISTRATION FORM. Find this form in the Fill-in PDF Folder on the Director CD. Copyright © 2010 Concordia Publishing House. Permission granted for purchaser to make copies for the year the VBS program is purchased.

 

 

VBS:Registration

 

 

 

Child Release Form for Picking-Up Children

(For use by any individual other than the child's legal parent/guardian,

unless designated as the daily pick-up person on the Registration Form)

 

 

 

Having been listed on the Child's Registration Form as a designated pick-up person by the child/children's parent or legal guardian, I acknowledge that I am picking up ___________________________________________________(name of child or children) from VBS on ____________________________ (date).

 

 

 

 

________________________________________

Signature

 

_________________________________________

Print Name

 

 

 

 

 

VBS:Release

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