SWBC VBS High Seas Expedition
SWBC VBS High Seas Expedition
July 12-16, 2010; 9 am-12 pm for kids entering Kindergarten through entering 5th grade
Child's Name
First
Last
Parent's Name
First
Last
Grade entering in fall of 2010
Kindergarten
First Grade
Second Grade
Third Grade
Forth Grade
Fifth Grade
Birthday
/
MM
/
DD
YYYY
Street Address
Town
Home Phone
-
(###)
-
###
####
Alternate Phone
-
(###)
-
###
####
Emergency Contact Name
Emergency Contact Phone
-
(###)
-
###
####
Food Allergies and Medical Concerns (Please Explain)
Doctor's Name
Doctor's Phone Number
-
(###)
-
###
####
Siblings attending VBS
Church Affiliation
People who may pick up this child
I hereby grant the VBS leaders permission to photograph/film the minor(s) designated above an any manner or form for any lawful purpose associated with this VBS program.
Yes
No
