AIM VBS 2026

Name

First NameLast Name
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender
Grade Level In School
Bathroom assistance?
Any known allergies?
Other medical conditions?
Fears and dislikes?
Communication?

Other
Does your child need feeding instructions/restrictions/special diet?
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.Format: (000) 000-0000.
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
Signature
Should be Empty:

Parent or Guardian Information