VBS-Child Registration Form 2025

Date:

Name

Date of Birth

Age

Address

Phone

Please list both parents names, if either parent will be picking up child(ren).

Parent/Legal Guardian(s) Name

This address will receive a confirmation email

LFBC Guest of

Emergency Contact NAME #1:

Emergency Contact PHONE # 1:

Emergency Contact NAME #2

Emergency Contact PHONE # 2:

Permission granted in emergency to transport to closest/local hospital if parent(s)/guardian(s) or emergency contacts cannot be reached?

Yes No

Allergies: (including food)

Yes No

If yes, please list:

Sibling Name #1

Sibling Date of Birth #1

Sibling Age #1

Allergies Sibling #1

If yes, please list for Sibling #1

Sibling Name #2

Sibling Date of Birth #2

Sibling Age #2

Allergies Sibling #2

If yes, please list for Sibling #2

Sibling Name #3

Sibling Date of Birth #3

Sibling Age #3

Allergies Sibling #3

If yes, please list for Sibling #3

Sibling Name #4

Sibling Date of Birth #4

Sibling Age #4

Allergies Sibling #4

If yes, please list for Sibling #4

Person Other Than Parent(s)/Legal Guardian Picking Up

Church Home

PHOTOGRAPHS: I grant permission for L.F.B.C. to photograph my child(ren) for website and Church social media sites:

Yes No

FOR SAFETY MEASURES, YOUR CHILD(REN) WILL NOT BE ALLOWED TO LEAVE WITH ANY OTHER PERSON(S) OTHER THAN THE PERSON(S) LISTED ABOVE. THEY WILL NEED TO STOP BY THE REGISTRATION OFFICE FIRST. A PICTURE ID WILL BE REQUIRED TO SIGN YOUR CHILDREN OUT.

I have read this statement.

Description

VBS-June 23-27, 2025 6:30 pm-8:00 pm

Please fill out this form and click submit.

VBS-Child Registration Form 2025

Description

Please Fix the Following