2025 Vacation Bible School - Child Registration Form

Child Registration

Child Information

Name*

First NameLast Name

Gender

Date of Birth*

Date

Age*

2025/2026 Grade*

Address*

Street Address

CityState

Zip Code

Allergies, Dietary, Medical, Behavioral, or Special Needs

Any information leaders should know about your child to make his/her VBS the best experience possible

My Child Would Like To Be In The Same Group As

Leaders will do their best to honor same group requests

Group Assignment

Hidden Field for Use on Excel Table

Parents / Guardians Information

Mother Father Guardian*

Name*

First NameLast Name

Best Contact Phone*

NumberFormat: (000) 000-0000.

Email*

Important VBS information is communicated by email

Mother Father Guardian N/A*

Name*

First NameLast Name

Best Contact Phone*

NumberFormat: (000) 000-0000.

Email*

Important VBS information is communicated by email

Emergency Contact - Adult Other Than Parent / Guardian

[An attempt will be made to first contact Parent(s) / Guardian(s)]

Name*

First Name, Last Name

Best Contact Phone*

NumberFormat: (000) 000-0000.

Adult Other Than Parent / Guardian Responsible for Picking Up Child

Name

First Name, Last Name

Best Contact Phone

NumberFormat: (000) 000-0000.

Consent to Participate and Authorization for Medical Care

YES NO* I hereby give permission for my child to participate in the children activities of De Soto United Methodist Church. I also hereby authorize the officials (staff and volunteers) of De Soto United Methodist Church and/or its representatives to give consent for any and all necessary emergency medical care for my child when said child is participating in De Soto United Methodist Church activities, June 23-26, 2025.

Consent to Release Images

YES NO* I understand that my child may be photographed while participating in activities at De Soto United Methodist Church, June 23-26, 2025. I authorize permission for photos of my child to be used in slide shows, general worship settings, and church print and electronic publications. I understand that no names of children will appear in the captions of the photos.

Acknowledgement

BY SIGNING BELOW, I ACKNOWLEDGE THAT THE ABOVE INFORMATION IS TRUE AND ACCURATE AND IF APPLICABLE, THAT I HAVE BEEN AUTHORIZED BY A PARENT OR GUARDIAN TO COMPLETE THIS FORM ON THEIR BEHALF. FURTHERMORE, I ACKNOWLEDGE THAT I AM AFFIXING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE AND WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature*

Type Full Name

Date*

Date

8760 Kill Creek Road - De Soto, Kansas 66018 - 913.583.1359 - www.desotoumc.org