HIGHLAND SDA SPANISH CHURCH
Trusting Jesus in a Wild world
JUNE 20-June 24 2025
6:00 P.M.-8:30 P.M.
Registration Date
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Month
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Day
Year
Date
Student Name
First Name
Last Name
Allergies
*
Age
Date of Birth
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Month
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Day
Year
Date
TEE SHIRT SIZE
*
Gender
Male
Female
Grade Level
Student Name
First Name
Last Name
Allergies
Allergies
Age
Date of Birth
-
Month
-
Day
Year
Date
TEE SHIRT SIZE
Gender
Male
Female
Grade Level
Student Name
First Name
Last Name
Allergies
Age
Date of Birth
-
Month
-
Day
Year
Date
TEE SHIRT SIZE
Gender
Male
Female
Grade Level
Student Name
First Name
Last Name
Allergies
Age
Date of Birth
-
Month
-
Day
Year
Date
TEE SHIRT SIZE
Gender
Male
Female
Grade Level
Parent/Guardian Information
Name 1
*
First Name
Last Name
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Relationship
*
Phone Number
*
Please enter a valid phone number.
Name 2
First Name
Last Name
Relationship
Phone Number
Please enter a valid phone number.
Email
example@example.com
Authorized person who can pickup the child on dismissal
*
First Name
Last Name
Agreement
I allow my child to participate in this vacation bible school program.
I authorize the volunteer personnel to conduct first aid, and medical care in the event of an emergency situation. I agree to pay for all the medical care expenses and costs in a given situation that medical care is needed.
I release the church from any liabilities that might happen during the activity and hold them harmless in the event of damages, injuries, or accidents.
I confirm that all information in this form is accurate and true to the best of my knowledge.
Would it be okay if we take photos and videos of the participant during the activity which will be posted in our social media account?
Yes
No
Date Signed
*
-
Month
-
Day
Year
Date
Parent/Guardian SignatureEmail
*
example@example.com
Save
Submit
Home Phone
Please enter a valid phone number.
Should be Empty: