VBS

Redlands Community Church

14601 SW 248th Street, Homestead, FL 33032

305-258-1132

9:00am- 12:00pm

Registration Form

(Children entering grades K5-6 only)

Child’s Name: _____________________________________Date of Birth: _____________________________

School Grade Entering in August: _____________Home Church (if any) ____________________________

Parent(s) Name(s): ___________________________________________________________________________

Address: ____________________________________________________________________________________

E-mail: _________________________________ Cell Phone:__________________________________________

If parent is unavailable in an emergency, contact: __________________________________________________

Relationship:____________________________ Phone: ___________________________________________

Food Allergies ___________________________ Other allergies/Medical conditions______________________

I hereby _________ GRANT or ________ DO NOT GRANT (choose one) permission for Redlands Community Church to use pictures of my child on their website for informational or promotional purposes. I, the parent or guardian, of ________________________ authorize adult volunteers of Redlands Community Church to consent to any medical or surgical care deemed advisable by an accredited physician or surgeon in the event of an emergency. I release Redlands Community Church, its ministries, or leaders from any liability in the event of an accident during the VBS week. I consent to Redlands Community Church using my e-mail address to send me VBS information each year.

___________________________________________Date: __________________

Parent/Legal Guardian (Print)

___________________________________________

Parent/Legal Guardian (Signature)

Launch Form