Vacation Bible School 2023 - Child Information Form

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Monday, July 10 - Friday, July 14, 2023 at St. Paul Lutheran Church Sheboygan

Email *

Parent(s)/Guardian Name (first/last and relation to the child(ren)) *

Daytime Phone (specify cell phone/work phone) *

Family Address (street, city, zip) *

Emergency Contact Name(s) & Phone Numbers *

Emergency Contact's Relationship to the Child *

Who else is allowed to pick up your child from VBS this week besides the parent/guardian listed. Please indication the relationship of the person/people to the child. *

What school do(es) your child(ren) attend? *

Home Church *

Pastor's Name(s) *

Child #1 First & Last Name (Preferred nickname in parentheses) *

Child #1 Date of Birth *

YYYY

Child #1 is going into what grade for the 23/24 school year... *

Child #1 Food Allergies/Sensitivities (comparable snack options will be accommodated to the best of our abilities)

Child #1 Other Health Concerns

Child #2 First & Last Name (Preferred nickname in parentheses)

Child #2 Date of Birth

YYYY

Child #2 is going into what grade for the 23/24 school year...

Child #2 Food Allergies/Sensitivities (comparable snack options will be accommodated to the best of our abilities)

Child #2 Other Health Concerns

Child #3 First & Last Name (Preferred nickname in parentheses)

Child #3 Date of Birth

YYYY

Child #3 is going into what grade for the 23/24 school year...

Child #3 Food Allergies/Sensitivities (comparable snack options will be accommodated to the best of our abilities)

Child #3 Other Health Concerns

Child #4 First & Last Name (Preferred nickname in parentheses)

Child #4 Date of Birth

YYYY

Child #4 is going into what grade for the 23/24 school year...

Child #4 Food Allergies/Sensitivities (comparable snack options will be accommodated to the best of our abilities)

Child #4 Other Health Concerns

Parent Signature (electronic - please type full name) *

Send me a copy of my responses.

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