The Atmosphere Church Shine Brightly with Jesus!
Vacation Bible School Registration Form
Complete one form per family. Please list all children attending VBS below.
VBS Dates: June 24th-June 26th VBS Time: 6:30-8:30 PM
Family/Household Information
Family Last Name:
Home Church (if applicable):
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about VBS?
Children Attending VBS
Children Attending VBS
Rows
Full Name
Date of Birth
Age
Grade Completed (25-26)
Days Attending June 24th-26th
1
2
3
4
5
6
7
8
Parent/Guardian Information
Parent/Guardian 1 Name:
Relationship:
Cell Phone:
Format: (000) 000-0000.
Email:
example@example.com
Parent/Guardian 2 Name:
Relationship:
Cell Phone:
Format: (000) 000-0000.
Email:
example@example.com
Emergency Contact Information
Emergency Contact Name:
Relationship:
Phone:
Format: (000) 000-0000.
Alternate Emergency Contact:
Phone:
Format: (000) 000-0000.
Medical Information for Each Child
Medical Information for Each Child
Rows
Child Name
Allergies
Medical Conditions / Special Needs
1
2
3
4
5
6
7
8
Transportation Information
Person Authorized to Drop Off Child(ren):
Person(s) Authorized to Pick Up Child(ren):
Additional authorized pickup names:
Photo & Video Release
I give permission for my child(ren) listed on this form to be photographed and/or recorded during VBS activities.
Yes
No
Parent/Guardian Consent
I certify that the information provided is accurate and give permission for all child(ren) listed on this family registration form to participate in VBS activities sponsored by The Atmosphere Church.
Parent/Guardian Signature:
Date:
-
Month
-
Day
Year
Date
"Let Your Light Shine Before Others" - Matthew 5:16
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