Vacation Bible School Registration & Health Form

Vacation Bible School Registration & Health Form

2019 - Please mail payment to: United Methodist Church, PO Box 148, Coon Rapids, IA 50058 . - attn: Mandy Smouse
Personal Information of Camper

First Name Last Name
Gender
Age the week of VBS (June 17th) *
Grade Entering
Birthdate

Month Day Year
Date Date Picker Icon

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent/Guardian Name
Parent/Guardian Phone Number

Area Code Phone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent/Gaurdian Email
example@example.com
Emergancy Contact's Name and Phone Number
Siblings Attending VBS
Siblings Attending VBS
Siblings Attending VBS
General Health Information: Chronic or Recuring Health Issues that may affect VBS
Food Allergies
Dietary Restrictions
Medications (kinds/dosage)
Does the camper have current health insurance? Yes/No and Policy Holder's Name
Dismissal Information: Name(s) of person(s) who may pick up this child from VBS.
I give permission for my child to participate in all aspects of Vacation Bible School except as noted *
I understand that every effort will be made to contact me if my child needs emergency medical treatment *
I authorize medical personnel or VBS staff to secure any medical or emergency treatment as deemed necessary for my child *
I give permission for any picture of my child to be used for promotional and social media purposes *
Parent/Guardian Signature
We ask that you please sign this form the first morning of VBS or print a copy and send with your child the first day.
Date Completed

Month Day Year
Date Date Picker Icon
Type a question
Type a question
I am interested in a scholarship for my child(ren) to attend
This information is all kept confidential.
Please include any other information you may feel might be useful to those spending the mornings with your child(ren) during VBS week:

2018 Vacation Bible School Conduct Covenant

As a participant in VBS and a Child of God, I understand and agree to the following expectations:
- I will choose to participate fully in Vacation Bible School.
- I will choose to respect all people, including myself, choosing to treat others as I would like to be treated.
- I will choose to listen to the VBS leadership team and volunteers.
- I will choose to use my words to build others up or I will choose to be quiet.
- I will not bring harm to myself. I will choose to maintain self-control.
- I will choose to be respectful of the facilities and grounds where VBS is held. I understand that if I damage other people’s property, I am responsible for replacing/repairing it.
I understand that if I choose to break this Conduct Covenant, there are consequences. I will take responsibility for my actions. I understand that if I choose to harm myself or others, my parent/guardian will be contacted and I will be sent home.
Camper's Signature
I have read this Conduct Covenant and enter into it with my child. I will encourage my youth to abide by it. I understand that should my youth choose to break this Covenant, every effort will be made to contact me and my youth will be sent home. I also understand that if I am not reachable, the emergency contact will be contacted.
Parent/Guardian Signature
Please submit this form, you will be asked to sign the form in person on the first evening of VBS.

______________________________________Date_____/_____/________
Should be Empty: