Bible School Registration
Sign in to Google to save your progress. Learn more
Email *
Child's Name *
Age
Child's Birthdate *
MM
/
DD
/
YYYY
Mailing Address - Street Name *
Mailing Address - City *
State *
Mom/Guardian's Name *
Mom/Guardian's Phone # *
Dad/Guardian's Name *
Dad/Guardian's Phone# *
Emergency Contact - name *
Emergency Contact - relationship to child *
Emergency Contact - phone number *
Food Allergies *
Required
Other Allergies
Other Medical or Behavioral Information
How did you hear about VBS? *
Required
Please list names of others who are permitted to pick up your child from VBS:
In case of an accident or illness, do you the parent or guardian consent to allow volunteers of CSHC to call paramedics, a licensed physician, or dentist for your child? - Your selection constitutes an electronic signature. *
I/we, the parent(s), agree to assume financial responsibility for expenses incurred as a result of these services provided. Your selection constitutes an electronic signature. *
I/we, the parent(s), consent that the volunteers of CSHC may consent to an x-ray, anesthetic, medical, surgical, or dental diagnosis or treatment, which is in the best judgement of a licensed physician or dentist. Your selection constitutes an electronic signature. *
I hereby give my permission for my child's picture to be used in video or photography promoting CSHC. Your selection constitutes an electronic signature. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms