Vacation Bible School Registration Form
Are you enrolling your child in VBS at University Parkway SDA, Blue Angel Parkway SDA, or both locations?
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Please Select
UPSDA June 25-29
BAPSDA July 23-27
Both Locations
Section I
Please complete all relevant items in Section I. Section II is only required if your child has allergies, food sensitivities or special needs.
Child's First and Last Name
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First Name
Last Name
Childs Nickname
Child's Age
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Please Select
3
4
5
6
7
8
9
10
11
Child's Date of Birth
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-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian #1 Name
*
First Name
Last Name
Parent/Guardian #1 Email
*
example@example.com
Parent/Guardian #1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian #2 Name
First Name
Last Name
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Custodial Agreement If Applicable
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Email
*
example@example.com
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
In case of emergency, please indicate if you give permission for us to call 911 in case of emergency.
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Yes
No
Signature
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Photographs will be taken during VBS. Please select "Yes" and sign below if you give permission for your child's photo to be taken.
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Yes
No
Signature
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Does your child have any allergies, food sensitivities or special needs?
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Yes
No
Section II
We are excited to have your child here at VBS! We believe that every child has God-given strengths and abilities. We would love to get to know your child better in order to encourage these strengths and abilities as well as to support them in the areas where they may need additional help. Please fill out the form below so we can get to know your child better.
My child has the following allergies and/or food sensitivities:
My child has the following educational label or medical diagnosis:
My child's primary means of communication is:
My child’s favorite activities and interests are:
My child avoids doing or becomes easily frustrated with the following activities:
If my child becomes overwhelmed or frustrated they will respond best to:
My child’s strengths are:
My child needs help with:
What suggestions do you have that may help us create the best possible experience for your child?
What information would you like us to share with other children at VBS that will help them to better know, accept and understand your child?
Submit
Submit
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