VBS Form – Chehalis Seventh-Day Adventist Church

Vacation Bible School
Chehalis Seventh-day Adventist Church
2024 REGISTRATION FORM
Monday, July 15 — Tuesday, July 16 — Wednesday, July 17 — Thursday, July 18 — Friday, July 19 — Saturday, July 20

CHILD AND PARENT/GUARDIAN INFORMATION:

Child's Last Name

First Name

Date of Birth

Age

Grade in Fall 2024

Child's Last Name

First Name

Date of Birth

Age

Grade in Fall 2024

Child's Last Name

First Name

Date of Birth

Age

Grade in Fall 2024

Child's Last Name

First Name

Date of Birth

Age

Grade in Fall 2024

T-Shirt Size(s)

Address: Street/PO Box

City, State

Zip Code

PARENT/GUARDIAN INFORMATION:

Name:

Address: Street/PO Box

City,State

Zip

Home Phone:

Cell Phone:

Work/Other Phone:

Email:

MEDICAL INFORMATION

Please indicate any specific concerns about your child’s allergies, medical concerns, cognitive disabilities, history of trauma or abuse, behavioral diagnosis, etc. including if they will carry Epi-pens or Inhalers:

EMERGENCY CONTACTS

Name

Phone Number

Relationship to the Child

Name

Phone Number

Relationship to the Child

DISMISSAL INFORMATION

Name the person(s) who may pick up this child/children from VBS each day:

Name

Phone Number

Relationship to the Child

Name

Phone Number

Relationship to the Child

PERMISSION

Consent Agreement

By clicking the box, I give permission for my child to be photographed or videotaped as part of VBS activities. I recognize that his/her image may appear in a church or community publication:

Date

(360) 748-4330

office@chehalissda.org

120 Chilvers Rd,
Chehalis, WA 98532

(360) 748-4330

office@chehalissda.org

120 Chilvers Rd,Chehalis, WA 98532

120 Chilvers Rd,
Chehalis, WA 98532