"*" indicates required fields
Parent/Guardian's First Name*
Parent/Guardian's Last Name*
Parent/Guardian's Email Address*
Parent/Guardian's Phone Number*
Parent/Guardian's Address*
Emergency Contact Name*
Emergency Contact Phone*
Please make sure that the emergency contact person WILL BE AVAILABLE from 9:00am to 12:00pm.
1st Child
Child's Name
Grade —Please choose an option—Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Allergies
2nd Child
3rd Child
We realize that things come up and if you are unable to pick your child/children up, for his/her safety, please supply names of person/people that are allowed to pick up your children:
Name:
Relationship
Due to the expected high volume for VBS and, for the purpose of class planning, we must insist upon strict age and grade assignments for each class. We are not able to make special arrangements to place family or friends together if not of the same grade or age.*
I hereby give permission for my child/children to attend Valley Bible Church Vacation Bible School.* I hereby give permission for my child /children to be released to go to the City of Pacific Free Lunch Program at noon at the city gym, rather than be picked up by a parent. By giving permission you release Valley Bible Church and staff from any responsibility once child/children leave our care. I hereby release Valley Bible Church, Pacific, WA, their staff, leaders, and volunteers from any and all claims and liabilities of whatsoever nature both individually and collectively that may arise from my child's participation in the Vacation Bible School program and activities. I further agree that Valley Bible Church representatives are authorized to seek such medical, dental, surgical care, or treatment as may be necessary for my child during his/her participation in Vacation Bible School.*
(*) Denotes required fields
