KidzWeek (VBS) Registration - Scottdale, PA Assembly of God

PRE-REGISTER WITH THIS FORM AND YOUR KIDS GET A PRIZE!!!
I give permission for the following child/children to attend KidzWeek (VBS) at Scottdale Assembly of God, August 11th-14th from 6:30 PM - 8:00 PM:
Child's Name 1*

First NameLast Name
List allergy concerns: (Please indicate "none" if there aren't any)*
1st Child's Grade in Fall of 2025*
List medical concerns: (Please indicate "none" if there aren't any)*
Child's Name 2 (if applicable)

First NameLast Name
2nd Child's Grade in Fall of 2025
List allergy concerns: (Please indicate "none" if there aren't any)
List medical concerns: (Please indicate "none" if there aren't any)
Child's Name 3 (if applicable)

First NameLast Name
3rd Child's Grade in Fall of 2025
List allergy concerns: (Please indicate "none" if there aren't any)
List medical concerns: (Please indicate "none" if there aren't any)
Child's Name 4 (if applicable)

First NameLast Name
4th Child's Grade in Fall of 2025
List allergy concerns: (Please indicate "none" if there aren't any)
List medical concerns: (Please indicate "none" if there aren't any)
Child's Name 5

First NameLast Name
5th Child's Grade in Fall of 2025
List allergy concerns: (Please indicate "none" if there aren't any)
List medical concerns: (Please indicate "none" if there aren't any)
Parent(s)/Guardian(s) Information

Only those listed here will be authorized to pick-up the child/children attending the KidzWeek Event (Please provide name as listed on photo ID)
Name:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Relationship to child/children*
E-mail*
Name (if applicable):

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child/children
Name (if applicable):

First NameLast Name
Relationship to child/children
Phone Number

Area CodePhone Number
Emergency Contact Name if Parent/Guardian Cannot Be Reached:*
Emergency Phone #:*
Emergency Contact Relationship:*
Same as aboveDifferent
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Pictures will be taken of the children during the VBS program that could potentially be on the church Facebook page. Forms will be available at the church if you do not want your child's picture included.
www.scottdalefirstag.org
Should be Empty:

PRE-REGISTER WITH THIS FORM AND YOUR KIDS GET A PRIZE!!!

I give permission for the following child/children to attend KidzWeek (VBS) at Scottdale Assembly of God, August 11th-14th from 6:30 PM - 8:00 PM:

Parent(s)/Guardian(s) Information