Vacation Bible School 2018 Student Form

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Child's Information

Name *

Date of Birth *

Age *

Allergies, Dietary, Medical, Behavioral, Special Needs, Requests to Be Grouped with a friend, etc...

Parent or Guardian Info

Parent(s) or Guardian(s) Full Name *

Address *

City *

Zip / Post Code *

Email *

Home Phone

Cell Phone *

Work Phone

Emergency Contact Info

Emergency Contact Name *

Emergency Contact Phone *

Caregiver Responsible for Picking Child Up

Name *

Caregiver's Best Contact Phone *

Relationship To Child *

Parent/Guardian's Participation Consent Signature

Date of Participation Consent

Parent/Guardian's Image Consent Signature

Date of Image Consent

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Click the Submit button below to submit your information. Please print and complete the permission page that pops up right after your click the Submit button. Bring that form with you to the first day of VBS.