Child #1 Name *

First Name

Last Name

Child Is A: *

Boy

Girl

Date of Birth *

MM

DD

YYYY

Child #2 Name

First Name

Last Name

Child Is A:

Boy

Girl

Date of Birth

MM

DD

YYYY

Child #3 Name

First Name

Last Name

Child Is A:

Boy

Girl

Date of Birth

MM

DD

YYYY

Child(ren)'s Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do we have permission to take photos of your child(ren) to use for Seaside promotional purposes? (Note: No photos of your child will be posted to Seaside social media accounts or any social media accounts of our volunteers.) *

Yes

No

Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Additional Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Authorized End of Day Pick-Up Person (Who will be picking up your child(ren)? Note: You may be asked to show a valid photo ID at the time of Child Pick-Up. Your child(ren) may not be released without proper identification. Thank you for your cooperation.): *

First Name

Last Name

End of Day Pick-Up Person Phone Number *

(###)

###

####

Code of Conduct: If your child exhibits unacceptable behavior while at Vacation Bible School, you may be called and asked to pick them up. Your child may be asked not to return for the remainder of VBS. Vacation Bible School will be full of activities, games, and a lot of moving around! For that reason belongings such as video games, toys, etc., should be left at home. Seaside United Methodist Church is not responsible for items that are lost or stolen. *

I agree to this code of conduct

I do not agree to this code of conduct

Permission Waiver: I give my permission for my child(ren) to participate in Vacation Bible School taking place June 10-14, 2024, at Seaside United Methodist Church. I understand the known risks involved and hereby fully release and forever discharge the parties named above, along with heirs, officers, agents, employees, and volunteers. • In the event of illness or accident, having parental responsibility for the above named child, I give permission for first aid to be administered where considered necessary by a person trained in first aid, if available, or medical treatment to be administered by a suitably qualified medical practitioner. • If I cannot be contacted and my child should require emergency hospital treatment, I authorize an adult leader to sign on my behalf any written form of consent required by the hospital. However, I understand that every effort will be made to contact me as soon as possible. *

I give permission

I do not give permission

How did you hear about this event? *

Facebook/Social Media

Banner Outside Church

Flyer in School

Church Website

Friend

Other

Parent/Guardian Electronic Signature *

First Name

Last Name

Date of Signature *

MM

DD

YYYY