VBS Registration Form – Berean SDA Church

VBS Registration Form

Step 1 of 2

Child Information

Name *

First

Last

Crew Leader Name

Child’s nickname:

Child’s age:

Date of Birth

Name of parents/guardians:

Single Line Text

Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian Information

Name *

First

Last

Email *

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Custodial arrangement if applicable:

Allergies or other medical conditions (i.e. diabetes):

Emergency Contact

Name *

First

Last

Phone

Relationship to child:

I give permission to call 911 in case of emergency.

Enter digital signature here.

Photographs will be taken during VBS. My signature indicates I am giving permission for my child’s photo to be taken.

Enter digital signature here.