Parent/Guardian Name

Child's Name

Address

Home or Work Phone

Cell Phone

Your Email Address

Child's Birthdate

Last Grade Completed

Medical Information (Please include any food allergies)

Emergency Contacts (in case we can't reach you)

Other Information (Does your child attend Sunday school? If so, where? Are they a guest to Calvary? If so, a guest of whom?)

Do we have permission to photograph your child? Do we have permission to photograph your child? Yes No

Do we have permission to use your child's photo for promoting VBS? Do we have permission to use your child's photo for promoting VBS? Yes No

Authorized Pickup People (please list the adults other than yourself, that are authorized to pickup your child from VBS)

Acknowledgement of Safety & Security Acknowledgement of Safety & Security I acknowledge and agree that for the purpose of the safety and security of my child, only myself or the adults listed above are authorized to pickup my child from Vacation Bible School at Calvary Baptist Church. Children will not be released to the custody of a sibling or any other adult not listed above.