Child's Information

Child's Name

First Name

Last Name

Date of Birth

YYYY

Grade Level (2025-2026 School Year)

Shirt Size

Please indicate if your child wears a Youth or Adult size. EX. Youth Large, Adult Small, etc.

Allergies

Type "NONE" if there are no known allergies.

Special Instructions

Does your child have any specific needs that we should be aware of to provide the best support and care possible during VBS? Examples may include food preferences or sensitivities and/or neurodivergent characteristics.

Media Release

I understand that my child's image or photo may be used in church-produced materials, including, but not limited to, bulletins, posters, brochures, newsletters and other printed materials, and on the church website and social media platforms. No identifying information will accompany photos, including names, addresses, email addresses, family members’ names, or schools.

Parent/ Guardian Information

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Information

Emergency Contact Name

This person will also have authorization to drop off and pick up your child.

First Name

Last Name

Relationship to Child

Phone

(###)

###

####