VBS Registration Form

REGISTRATION FORM

Rainforest Explorers

June 22-25, 2020

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:

 

  1. allergies: (Please circle) Yes____No__(List:) _________________________________________________

 

  1. 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).

 

 

 

 

________________________________________

Signature

 

_________________________________________

Print Name

 

 

 

 

 

 

 

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