VBS Child Registration Form - St. John's Episcopal Church

Montgomery Convocation of Episcopal Churches presents…

June 3-6, 8:30 – Noon
Rising K4 – Rising 6th Grade

COMPLETE ONE FORM PER CHILD
Pre-Reservation Deadline May 20, 2019
Name*
First Last
Name Child Goes By*
Age*
Date of Birth*
MM
DD
YYYY
Grade in 2019-2020*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Parents' Names*
Email Address*
Home Phone*
Work Phone
Cell Phone
Please indicate which number we should call you during the VBS hours*
- Home Phone
- Work Phone
- Cell Phone
Special Needs or Medical Conditions
Allergies or Food Restrictions
Home Parish*
I give permission for my child to travel off the campus of St. John's Episcopal Church with their VBS instructors in either vans owned by St. John's, or the Church of Ascension Bus.*
- Yes, I give permission
- No, I do not give permission
I give my permission in the event of an emergency to seek medical treatment for my child.*
- Yes, I give permission
- No, I do not give permission
I give my permission for the church to use pictures of my child on their website and social media for informational or promotional purposes.*
- Yes, I give permission
- No, I do not give permission