Emergency Contacts in the event that the Parent / Guardian CANNOT be reached

I authorize the following people to pick up my child from VBS

Name
Relationship
Phone# Area Code   Phone Number 

Name
Relationship
Phone# Area Code   Phone Number 

Please Note: (children ages 3-5 must be toilet trained to be accepted)

Children Attending:

Child Name
Age  
Grade Fall 2025   
Allergies/Medical Conditions     
T-Shirt Size      

Child Name
Age  
Grade Fall 2025   
Allergies/Medical Conditions     
T-Shirt Size         

Child Name
Age  
Grade Fall 2025   
Allergies/Medical Conditions     
T-Shirt Size      

Child Name
Age  
Grade Fall 2025   
Allergies/Medical Conditions     
T-Shirt Size 

*VBS will provide one T-shirt per child* We ask that you wash it daily and have your child wear it every day!! Additional T-shirts are available for only $8.00


Date   Signature   

Reason for which release is intended:

Vacation Bible School 2025 at El Faro Assembly of God Inc

Name of Minors:
child child   child   child    child    

Address of Minors:
 Street Address    City   StateZip  
 
Emergency Phones:
Phone Number   Phone Number  

Family Physician:
First Name   Last Name  Phone: Phone Number      

Physicians Address:
   Street Address   City   State   Zip   

Emergency Phone Area Code  Phone Number 
Secondary Emergency Phone Area Code Phone Number