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VBS 2019: In the Wild!
Online Registration Form. Vacation Bible School is June 10-14. 6:30-8:30 PM, M-F, @ Indiana Alliance Church, 2510 Warren Rd., Indiana PA For help call 724-463-0862
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Email
*
Your email
Child Name: First & Last
*
Your answer
Child's Mailing Address
*
Your answer
My child is entering grade:
*
Choose
Preschool or Pre-K (Age 3,4,5)
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
HELP US KNOW MORE ABOUT YOUR CHILD
Does your child have any food allergies?
*
Choose
Yes
No
If yes, please list all allergens here:
Your answer
PARENT/GUARDIAN INFORMATION
Name of Parent(s)/Guardian(s):
*
Your answer
Is your address the same as your child's?
*
Choose
YES
NO
If No, please provide your full address here:
Your answer
EMERGENCY INFO
This section is vital to ensure we know how to respond if your child becomes ill etc.
In the event of an emergency, I give permission to the Indiana Alliance volunteers/ staff to administer first aid and/or obtain emergency care from the nearest hospital.
*
Yes
No
PRIMARY CONTACT INFO
This is the first person we will call in the event that your child need picked up or in an emergency
Name of primary emergency contact:
*
Your answer
Cell phone number of primary contact:
*
Your answer
Home phone number of primary contact:
*
Your answer
SECONDARY EMERGENCY CONTACT PERSON
This person will be contact if necessary after the PRIMARY person could not be reached.
Name of secondary contact
*
Your answer
Cell phone number of secondary contact
*
Your answer
Home phone number of secondary contact:
*
Your answer
PERMISSION FOR PICTURES
We like to document the fun and capture memories to share with you.
Do you give permission to take your child's pictures to post on Facebook ? (possibly used for future promotional material or Indiana Alliance Church's website)
*
Yes
No
Option 3
Send me a copy of my responses.
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