Vacation Bible School 2019 Student Form If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required Child's Information Name * Date of Birth * Gender of Child * Male Female Female Age * Grade Completed * Preschool Kindergarten 1 2 3 4 5 Allergies, Dietary, Medical, Behavioral, Special Needs, Requests to Be Grouped with a friend, etc... Will your child be joining us for the optional meal at 5:30 pm? * Yes No Parent or Guardian Info Parent(s) or Guardian(s) Full Name * Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 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 * Consent to Participate & Authorization for Medical Care I hereby give permission for my child to participate in the children activities of DeSoto United Methodist Church. I also hereby authorize the officials(staff and volunteers) of DeSoto United Methodist Church and/or its representatives to give consent for any and all necessary emergency medical care for my child while said child is participating in DeSoto United Methodist Church activities July 22-25, 2019. Yes No Parent/Guardian's Participation Consent Signature Date of Participation Consent Image Consent I understand that my child may be photographed while participating in activities at DeSoto United Methodist Church, July 22-25, 2019. I authorize permission for photos of my child to be used in slide shows, general worship settings, and church print and electronic publications. I understand that no names of children will appear in the captions of the photos. Yes No Parent/Guardian's Image Consent Signature Date of Image Consent Please answer the following question so we know you are not a computer bot. What is 4 + 4? * 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.