Vacation Bible School Registration
August 4 - 8

Child's Name (Last, First)

Date of Birth: (MM/DD/YYYY)  
Grade Completed: -------------Preschool is fullKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade
Preschool - PreK Registration is Full

Parent/Guardian's Name:

Address:
City: State:  Zip:

Phone 1:
Phone 2:
Phone 3:

Person(s) Child May be released to & relationship to child:

Person to contact if parent is unavailable & relationship to child:

Phone number:

Physician Name:
Physician Phone:

Statement of Needs:
Please list any allergy, existing illness, previous serious illness, hospitalization, or any medication for prescribed long-term continuous use:

 (Please Check) Should my child need emergency treatment and listed parents or child's physician cannot be located, I hereby give permission for our child to be transported to the nearest doctor, hospital or emergency clinic, and the attending physician has our full permission to render any treatment he or she feels necessary.

Insurance Company:
Policy Number:

 (Please Check) Willow Meadows Baptist Church has my premission to photograph and/or video my child, and use these for publicity purposes such as brochures, websites and video broadcasts.

How did you hear about Vacation Bible School at Willow Meadows?

Yes! I would like to volunteer at VBS!
My Name is:  
My Phone and/or email:

Note to parents who register on-line:
You will be requested to sign a copy of this registration form before leaving your child on the first day of camp. 

Thank you!
We'll see you August 4th for VBS!