VBS 2023: July 30 - August 4

Please fill out this form and click submit.

Child's Name

*

Birth Date (month/day/year)

*

Address

*

Parent/Guardian Name

*

Phone

*

Email

*

This address will receive a confirmation email

I would like to receive communication on future events at the Westvale SDA Church.

*

Please select one option.

Yes No

Would your child like to be part of a children’s choir?

Please select one option.

Yes No

Emergency Contact Name and Phone Number

*

Food allergies

*

Please select one option.

Yes No

If yes, explain.

Medical or behavioral concerns

*

Please select one option.

Yes No

If yes, explain.

Church affiliation

*

Please select one option.

Yes No

If yes, which church?

Who may pick up your child?

*

Photo/Video Release

I hereby grant the VBS leaders permission to photograph/video the minor designated above for any manner or form for a lawful purpose associated with this VBS. Examples are the end of VBS slideshow and crafts involving his or her picture. Please select one option below.

*

Please select one option.

Yes No

By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

*

Description

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