VBS 2017 Registration

Child/Guardian Information.

Please submit a separate form for each child.

Child’s Name::*
Grade: *
Age Today:*
Legal Gaurdian's Name:*
Home Address:*
Home Phone:*
Alternate Phone:*

Emergency Contact Person:

ECP Name:*
ECP Phone:*
ECP Alternate Phone:*

Allergies and medical concerns

Known Food Allergies:*
List all known food allergies:*
Medical Conditions/Concerns:*
Medical Conditions or Concerns:*

If possible, all routine medications should be given prior to arriving, but if that is not possible and you need us to do so please list medication(s), doses, and any other information that would be helpful.
Our desire is that all children have the opportunity to participate in VBS, if there are any types of reasonable medical and/or physical accommodations that your child needs please list them and we will do our best to ensure they are taken care.

Note: If you do need us to administer medication to your child you will need to sign a note giving Lakehills VBS permission to do so.
I need Lakehills to give my child his/her medication:*
List medication(s) dosage info:*
My child needs special accomodations for medical or physical reasons:*
List all special accomodations required:*

In case of emergency

Family Doctor (in case emegancy contact cannot be reached):*
Doctor’s Phone:*

Siblings Attending VBS?

Siblings attending VBS?:*
1st Sibling Name:*
1st Sibling Age:*
2nd Sibling Name:
2nd Sibling Age:
3rd Sibling Name:
3rd Sibling Age:
4th Sibling Name:
4th Sibling Age:
5th Sibling Name:
5th Sibling Age:
6th Sibling Name:
6th Sibling Age:
7th Sibling Name:
7th Sibling Age:

Photo Consent/Release

Vacation Bible School (VBS) leaders have permission to photograph/film the minor(s) designated above for any lawful purpose associated with this VBS program (we will not publish the name of any child in photos or videos):*

Drop off and pick up

*Important: Parents/Guardians will need to be present at initial drop off in order to sign consent our form in person!!

Person(s) Who May Pick up your Child.

Name of first person allowed to pickup your child:*
Phone No. of first person allowed to pickup your child:*
Phone No. of second person allowed to pickup your child:*
Name of second person allowed to pickup your child:*
Signature (enter first and last name for electronic signature):*
Today's date:*
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