Seaside with the Savior

Registration Form

Child's Name
Grade Completed
Age
Birthday
Parent's Names
Parent Email
Home Address
Home Phone
Alternate Phone
Food Allergies	Yes No
If yes, list food allergies here:
Medical Concerns	Yes No
If yes, please explain:
Family Doctor
Doctor's Phone
Siblings attending VBS (names and ages)
Church Affiliation
Church Membership at
People who may pick up the child
Transportation needed?	Yes No
I hereby grant the VBS leaders permission to photograph/film the minors designated above in any manner or form for any lawful purpose associated with this VBS program.