VBS Registration : Prescott Seventh-day Adventist Church Prescott AZ

Child's Nickname

Child's Age

Date of Birth

Mother's Name

Father's Name

Guardian's Name

Address

Parent/Guardian Cell Phone

Parent/Guardian Email Address

Custodial arrangement, if applicable

Allergies or other medical conditions (i.e. diabetes)

Emergency Contact

Phone

Relationship to Child

I give permission to call 911 in case of emergency.

yes no

Photographs will be taken during VBS. My signature indicates I am giving permission for my child's photo to be taken.

yes no

Parent/Guardian Signature

Please PRINT name written above

SPECIAL NEEDS (optional)

We are excited to have your child here at VBS! We believe that every child has God-given strengths and abilities. We would love to get to know your child better in order to encourage these strengths and abilities as well as to support them in the areas where they may need additional help. Please fill out the form below so we can get to know your child better.

My child has the following educational label or medical diagnosis:

My child's primary means of communication is:

Additional information concerning my child's allergies or food sensitivities:

My child's favorite activities and interests are:

My child avoids doing or becomes easily frustrated with the following activities:

If my child becomes overwhelmed or frustrated they will respond best to:

My child's strengths are:

My child needs help with:

What suggestions do you have that may help us create the best possible experience for your child?

What information would you like us to share with other children at VBS that will help them to better know, accept and understand your child?

Prescott Seventh-day Adventist Church

VBS Registration

SPECIAL NEEDS (optional)

Related Information