VBS REGISTRATION FORM

BROOKSIDE FREE METHODIST CHURCH

2019 VBS JUNE 24 - 28
6:00 - 8:30

2019 VBS Registration Form

* Indicates required field

Child's Name *

First

Last

GENDER *

MALE FEMALE

Child's Birthday *

Grade Last Completed *

Medical / other information we need to know. Please include food allergies: (if none, please enter none) *

Parent/Guardian Full Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Primary Phone Number *

Secondary Phone Number *

Alternate Phone Number *

Home Church *

Emergency Contact Person (Name) *

First

Last

Primary Phone Number *

Alternate Phone Number *

In the event that I am unable to pick-up my child, the person named below has my permission to pick him/her up.

Is anyone else permitted to pick-up your child? *

Yes No

If yes, please enter name of person permitted. *

First

Last

Name 2nd alternate person permitted *

First

Last

We take photos during the week of VBS, those pictures are posted on facebook. Also, we livestream the VBS program. We ask permission to use your child's picture for this purpose only. We will try to the best of our ability to comply with your wishes.

I give permission to have my child's picture published. *

Yes No

Your Signature is required (typing your name & submitting form constitutes your signature) *

First

Last

Date *

Submit