AIM VBS 7/19/2025

Name

First NameLast Name
Birth Date

MonthDayYear
Date
Age
Gender

MaleFemale
Grade Level In School
T-shirt size

XSSMLXLXXLXXXL
Bathroom assistance?

Need assistance all the timeAssistance only if neededZero Bathroom assistance
Any known allergies?
Other medical conditions?
Fears and dislikes?
Communication?

VerbalWrittenGesturesPicture (Visual aid)Other
Does your child need feeding instructions/restrictions/special diet?

YesNo
If yes, please provide us with detailed explanation
Do you have any behavioral plan or instructions to help us make your loved one feel comfortable?
Parent or Guardian Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
LIABILITY:

THE APPLICANT NAMED ABOVE HAS MY PERMISSION TO PARTICIPATE IN
AIM VACATION BIBLE SCHOOL. I HEREBY RELEASE AND HOLD HARMLESS FROM ALL LIABILITY FOR ALL TYPES OF DAMAGES OR INJURIES,WHETHER FORESEEABLE OR NOT, SUSTAINED BY MYSELF, MY WATCHING/TRAVELING TO OR FROM THIS ACTIVITY, AND DO AUTHORIZE TO SEEK MEDICAL HELP IN AN EMERGENCY.
PHOTOGRAPHY CONSENT:

AIM/The Social Club/Mt Vernon Church has my permission to use any videography photography from VBS publically. I understand that the images may be used in the print brochure, website, and social media.
Participant
Guardian
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Parent or Guardian Information