VBS Registration – KingsWord Chicago

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Vacation Bible School Registration Form

Welcome to our Vacation Bible School! Please fill out the form below to register your child(ren). You can register multiple children using this form.

The suggested contribution is $25 per child.

Parent/Guardian Name *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Email Address

Phone Number *

Are you KingsWord Member? *YesNo

If NO How did you hear about us?

Participant(s) Information

Child's Full Name

Age

GenderMaleFemale

T-shirt Size

Allergies/Medical Conditions

Allergies/Medical Conditions:

Child's Full Name:

Age

GenderMaleFemale

T-shirt Size

Allergies/Medical Conditions:

Child's Full Name:

Age

GenderMaleFemale

T-shirt Size

Allergies/Medical Conditions:

Child's Full Name:

Age

GenderMaleFemale

T-shirt Size

Emergency Contact Information

Emergency Contact Name:

Relationship to Child(ren):

Emergency Contact Phone Number:

Medical Information

Family Doctor:

Doctor's Phone Number:

Photo Release Consent *

Photo Release: I give permission for my child’s photograph to be used for church promotional purposes.

Medical Release Consent *

Medical Release: In the case of a medical emergency, I give permission for the Vacation Bible School staff to seek medical treatment for my child.

Permission *

By signing this form, you agree to the terms and conditions of our Vacation Bible School.

Name and Date *

Please do not fill in this field.

Address:
4250 W Walton Street, Chicago IL 60651, USA

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