Medical Release:

VACATION BIBLE I will not hold the church responsible for any accident, but
SCHOOL should the unforeseen occur and my child needs emergency
medical care, the church has my permission to have my child
REGISTRATION treated by a competent medical physician if I (or the
emergency contact) cannot be reached.
Sun, August 8 – Thurs, August 12
6:00pm-8:15pm Parent/Guardian Signature _______________________________

* Join us for an opening Potluck Meal, Sun @ 5pm

Ages: 3 years through rising 6th grade
Please fill out a separate sheet for each child.
Child’s Name _______________________________________
Parent/Guardian Name(s) ______________________________
Photo Permission:
I grant permission for photographs of my child to be taken for
church use. Please note that occasional photos may be included
on the church website, but no personal information will be
included.
Parent/Guardian Signature ________________________________

Address __________________________________________ --------------------------------------------

City ___________________State ___ Zip Code ___________ VBS  is  a  ministry  in  which  we,  as  a  community  of  faith,  provide  for  our  
children.    When  possible,  we  encourage  parents  to  volunteer  in  some  
Home Phone Number _________________________________ way  so  that  we  may  all  be  a  part  of  this  fun,  family,  faith-­‐filled  
experience.  
Cell Phone Number ___________________________________
If  you  are  able,  please  indicate  below  where  you  are  willing  to  serve.  
E-mail address ______________________________________
 
Name of Emergency Contact ___________________________ Storytelling              Art                Music                Recreation              Service            Snacks    
Age-­‐group  leader  (shepherd)              Skits                Registration            Decorations        
Phone number for emergency ___________________________
Photography              Set-­‐up/Take-­‐down                Anywhere!!  
Home Church _______________________________________
If  you  are  not  available  during  regular  VBS  hours,  there  are  still  many  
Date of Birth ____________ School Grade (2010-11) _______ opportunities  to  help  in  preparation  for  VBS.    Please  let  us  know  your  
availability  and  areas  of  interest  below.  
Allergies/Medical Information __________________________

________________________________________________ _____________________________________________

(see other side) _____________________________________________