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Chosen Champions for Jesus
Student
Registration Form |
| Participant Information |
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| First
Name: |
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| Last
Name: |
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| Age: |
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| Address: |
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| City: |
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| Zip
Code: |
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| Contact
Information |
| Parent or Guardian(s) Name: |
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| Home
Phone# |
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| Work
Phone# |
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| Cell
Phone# |
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| Email
Address |
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| In Case of
Emergency |
| Emergency Contact Person: |
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| Phone
Number# |
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| Special
Needs |
| List
Allergies and Any Medical Conditions: |
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| Family Doctor and Phone Number: |
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| Does
Your Child Have Special Needs: |
Yes No |
| If Yes, Please state your child's special
needs: |
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| Please give specific details of any classroom supports that
will assist teachers (Sign Interpreter,Large Print Material,
Language Boards, etc.) |
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| General
Information |
| Last
Grade Completed |
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| Church Home |
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| Sibling(s) Attending Names(s) and Age(s) |
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| Person Who Will Drop Off |
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| Person Who Will Pick Up |
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| Your
Childs Extra Activities Area of Interest |
Creative StudiesMusic Appreciation
Praise Dancing
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| Disclaimer |
All information given on this form is kept in
confidence and will be helpful in assisting us to provide for your
child during their participation in Vacation Bible School. The VBS
Staff wiil not administer any medications to a child.
I
understand that reasonable precautions will be taken to safeguard my
child during His/Her time in VBS. I will not hold Power Hope and
Grace Bible Church or its VBS staff responsible for any accident or
loss that might be sustained. |
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| Signature of Parent(s) or Guardian(s) |
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| Date
Submitted |
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