RegistrationForm

Childs nickname

Childs age

Date of birth

Date

Name of parentsguardians

Street address

City

State

Zip

Parentguardians email address

example@example.com

Custodial arrangement if applicable

Allergies or other medical conditions (ie. diabetes)

In case of emergency contact

Relationship to child

I give permission to call 911 in case of emergency

Parentguardian signature

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

Parentguardian signature

If you would like to share any information regarding your child's special needs, please fill out the second page of this form.

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 educational label or medical diagnosis

My childs primary means of communication is

Additional information concerning my childs allergies or food sensitivities

My childs 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 childs strengths are

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