*1.Parent/Guardian Contact Information(Required.)

Name

Email Address

Phone Number

*2.Emergency Contact other than parent or guardian.(Required.)

Name

Phone Number

*3.Name of Child / Names of Children(Required.)

*4.Ages of your child(ren). Please check all that apply(Required.)

4-6 years old

7-10 years old

*5.Number of Children Bringing(Required.)

1

2

3

4

5

6.My child(ren) have the following allergies. Please include symptoms to look out for.

7.My child(ren) have the following special needs. Please include accommodations that will help our volunteers to provide the best support we can for our event.

*8.I give permission for my child(ren) to be photographed for the purposes of promoting VBS and children's programming at the Utica church of Christ.(Required.)

Yes, thanks for asking! You may include my child(ren) in photos.

No, we do not want our child(ren)'s photos taken.

9.My child(ren) attend Bible classes regularly (weekly or monthly). This statement is:

True

False

10.Our family would be interested in joining a small group, please contact me at the email or phone number provided on this form.

Yes

No

11.I would be interested in volunteering with the Utica church of Christ, please contact me at the email or phone number provided on this form.

Yes

No