2024 Vacation Bible School Registration Form

Vacation Bible School Registration Form
Name of the Child*

First NameLast Name
MaleFemale
Age
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Name of Church affiliation
YesNo
What are the allergies of your child?
YesNo
YesNo
What is this medical condition? Please elaborate below:
Pick Up Authorization

Authorized person/s to pickup your child after the Vacation Bible Study
Full Name 1*

First NameLast Name
Relationship*
Full Name 2

First NameLast Name
Relationship
Emergency Contact Information
Emergency Contact 1*

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Do you have any comments to add about your child?
Additional Child Registration

Register another child from the same household
YesNo
Name of the Child*

First NameLast Name
MaleFemale
Age
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name of Church affiliation
YesNo
What are the allergies of your child?
YesNo
YesNo
What is this medical condition? Please elaborate below:
Pick Up Authorization

Authorized person/s to pickup your child after the Vacation Bible Study
Full Name 1*

First NameLast Name
Relationship*
Full Name 1*

First NameLast Name
Relationship*
Emergency Contact Information
Emergency Contact 1*

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Consent
Do you have any comments to add about your child?
I allow my child(ren) to participate in this program. I give permission to allow the bible study conductor, volunteer personnel to conduct first aid, and medical care in the event of an emergency situation. I agreed to pay for all the medical care expenses and costs in a given situation that medical care is needed. (For in-person) I release the organizers 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.
YesNo
Parent/Guardian Signature

Clear
Date Signed

MonthDayYear
Date
Should be Empty:

Vacation Bible School Registration Form

Pick Up Authorization

Emergency Contact Information

Additional Child Registration

Pick Up Authorization

Emergency Contact Information

Consent