REGISTRATION FORM
Food Truck Party VBS June 12-15, 2023
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: ___________________________________________________________________________
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).
