Parent name
*
First Name
Last Name
Email
*
Primary phone
*
(###)
###
####
Additional phone
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency contact #1 name / relationship
*
Emergency contact #1 phone
*
(###)
###
####
Emergency contact #2 name / relationship
Emergency contact #2 phone
(###)
###
####
Person(s) authorized to pick up my child(ren)
Child #1 name
*
Child #1 date of birth
*
MM
DD
YYYY
Child #1 age as of 09/01/24
*
Child #1 last grade completed
*
N/A
3K
4K
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
Child #1 allergies / special needs
Child #2 name
Child #2 date of birth
MM
DD
YYYY
Child #2 age as of 09/01/24
Child #2 last grade completed
N/A
3K
4K
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
Child #2 allergies / special needs
Child #3 name
Child #3 date of birth
MM
DD
YYYY
Child #3 age as of 09/01/24
Child #3 last grade completed
N/A
3K
4K
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
Child #3 allergies / special needs
Child #4 name
Child #4 date of birth
MM
DD
YYYY
Child #4 age as of 09/01/24
Child #4 last grade completed
N/A
3K
4K
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
Child #4 allergies / special needs
Photography release
*
Your permission is completely optional. Occasionally, a Beautiful Savior representative may take photos for use on the church website, publications, and social media. Names or other identifying information are never shared. If you wish to grant permission to have your child photographed, please indicate so here. Please list any exceptions in the text box below.
Child #1 - I give permission
Child #1 - I give partial permission, as explained below
Child #1 - I do not give permission
Child #2 - I give permission
Child #2 - I give partial permission, as explained below
Child #2 - I do not give permission
Child #3 - I give permission
Child #3 - I give partial permission, as explained below
Child #3 - I do not give permission
Child #4 - I give permission
Child #4 - I give partial permission, as explained below
Child #4 - I do not give permission
Emergency release
*
In the event of illness or accident to a child or children of mine attending Beautiful Savior's Vacation Bible School, which in the judgment of the supervisor or other adult leader would seem to demand medical attention, I hereby authorize the said person to summon medical help at my expense if I cannot be promptly reached by phone. I further authorize the supervisor or other adult leader to cause my child's transportation to a place where appropriate medical aid can be rendered, if in his or her judgment such transportation is necessary.
If available, I would prefer that the doctor listed below be called at the number provided, but otherwise the supervisor or other adult leader shall use his or her own judgment as to the doctor to be called.
Agree
Disagree
Parent signature
*
Date
*
MM
DD
YYYY
Preferred doctor's name and phone number
*
How did you find out about Beautiful Savior's VBS?
*
Do you have a home church? If so, which one?
If you have any additional comments, please provide them here.