Vacation Bible School Registration Form
June 17-21, 9:30-11:50 AM for children completing grades K-5
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Child #1's name *
Child #1's Grade *
Child #1's shirt size *
There are more questions at the end of the form. Please skip ahead if you have no additional children to add. 
Child #2's name
Child #2's Grade
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Child #2's shirt size
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Child #3's name
Child #3's Grade
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Child #3's shirt size
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Child #4's name
Child #4's Grade
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Child #4's shirt size
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Child #5's name
Child #5's Grade
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Child #5's shirt size
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Address: Please include street number and name, city and zip code. *
Phone number: *
May we post your child's picture on the church bulletin board? *
Emergency Contact's Name: *
Emergency Contact's Phone Number: *
Any allergies or other medical conditions we should know about? Please specify which child(ren) this applies to. *
Please read and check the boxes that say "I agree" and "I am the parent or guardian to the above listed child(ren)".

I understand that, in the event that medical treatment is required, every effort will be made to contact me, however, if I cannot be reached, I give permission to the staff or sponsor to secure the services of a licensed physician or emergency responder to provide the care necessary, including anesthesia, for my child's well-being. I also understand that there are risks involved in events and activities and I do not hold Rothbury Community Church or its affiliates liable for accidents or injuries during the course of sponsored events or activities. 
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