2017 Vacation Bible School Registration


Edgewood Bible Church

This form should be completed for each child

Parent/Legal Guardian Information

First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
Zip Code:*
Phone Number (xxx-xxx-xxxx):*
E-Mail Address:*

Emergency Contact Information

Emergency Contacts should be local and available between 9:30-Noon the week of VBS. We will only contact the emergency contact if parent/guardian is not able to be reached.

First Name:*
Last Name:*
Phone Number (xxx-xxx-xxxx):*

Child Information

Your child MUST meet the following criteria entering the 2017-2018 School Year

  • 4 yrs old by 8/31/17
  • NOT entering 7th grade

NOTE: Due to expected high volume for VBS and for the purposes of class planning, it is necessary for us to insist upon strict age and grade assignments for each class. We are not able to make special arrangements to place family or friends together if they are not of the same age/grade.

First Name:*
Last Name:*
 4 year old
 1st Grade
 2nd Grade
 3rd Grade
 4th Grade
 5th Grade
 6th Grade
Shirt Size:
Allergy Information
Other Comments:

Receiving & Release

In the interest of maintaining safety, each child 'received' by Edgewood Bible Church will only be released to a listed authorized delegate. Edgewood Bible Church will require the authorized delegate to show picture I.D. to pick up child.

The following people have my permission to pick up my child.

Authorized Delegate Name 1:*
Authorized Delegate Name 2:
Authorized Delegate Name 3:

Please let us know if there are any custody issues that we should be aware of concerning your child.

Custody Issues:

Approval & Signature

I hereby release Edgewood Bible Church, Edgewood, WA, their staff, leaders, and volunteers from any and all claims and liabilities of whatsoever nature both individually and collectively that may arise from my child's participation in the VBS program and activities. I further agree that Edgewood Bible Church representatives are authorized to seek such medical, dental, surgical care, or treatment as may be necessary for my child during his/her participation in the VBS program. I further agree to provide Edgewood Bible Church representatives permission to take and post photos of VBS activities. By typing my name below and submitting this online form, I am agreeing that this is an electronic signature.

Typed Signature:
(Must be signed by parent
OR legal guardian)*