WANTED: Vacation Bible School Registration

Vacation Bible School Registration

Walker Pentecostal Church | 9969 Florida Blvd. | Erica Rouse 601.337.3159
Tuesday, July 28th - Thursday, July 30th- 6PM | Friday, July 31st- 7PM

Ages: 4 years - 12 years
Child Information
First NameLast Name
Date of Birth

MonthDayYear
Date
Age:
Gender:
Parent / Guardian Information
First NameLast Name
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact Information

If possible, this should be someone other than the parent.
First NameLast Name
Relationship to Child:
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical and Allergy Information
Does your child have any allergies (food, medication)?
Are there any medical conditions we should be aware of?
Does your child carry an EpiPen or any medication?
Authorized Pick-Up

Children will only be released to adults listed in this section unless written permission is provided.
Name

First NameLast Name
Relationship to Child:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship to Child:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship to Child:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Van Transportation

For questions, please contact: Heidi Fisher 📞 225.610.2241
Will your child need transportation to and/or from Vacation Bible School? Please check the box below and our transportation coordinator will contact you with pickup details.
Permission and Release:
I am the parent/legal guardian of the child listed above. By signing below, I give permission for my child to attend Vacation Bible School at Walker Pentecostal Church. In case of emergency, I authorize VBS staff/volunteers to seek necessary medical care for my child if I cannot be reached. I also give permission for my child to be photographed or recorded during VBS activities for church use, including social media, website, or printed promotions. I understand and agree to follow all child pickup and checkout procedures for the safety of all children.
Signature
Should be Empty:

Vacation Bible School Registration

Tuesday, July 28th - Thursday, July 30th- 6PM | Friday, July 31st- 7PM

Child Information

Parent / Guardian Information

Emergency Contact Information

Medical and Allergy Information

Authorized Pick-Up

Van Transportation

Permission and Release: