Child's Name
*
First Name
Last Name
Birthdate
*
MM
DD
YYYY
Gender
*
Grade Child will be going into for 2025-2026 school year
*
TK
kindergarten
1st
2nd
3rd
4th
5th
6th
T-Shirt Size
*
Child XS
Child S
Child M
Child L
Adult S
Adult M
Adult L
We love partnering with families on their faith journey. Is your family connected to a local church?
*
Yes, Regularly (3-4 time a Month)
Occasionally (1-2 times a Month)
On Special Occasions
Not Currently
We’re Looking For a Church
What is the name of the church you attend?
Date of last Tetanus immunization
*
Are there any known medical conditions/concerns?
Please list any known medical conditions/concerns:
Are there any medications you will be sending with your child?
Ex. Epi-pens, inhalers.
Please list medications that you will be sending with your child
Are there any known allergies?
Please list any known allergies
How did you hear about VBS this year?
Mother's Name
*
First Name
Last Name
Mother's Phone
*
(###)
###
####
Is it okay to text?
Mother's Email
Mother's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Father's Name
First Name
Last Name
Father's Phone
(###)
###
####
Is it okay to text?
Father's Address
Only add if different than mother's address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Father's Email
What is the best way to get info to parents
Email
Text
Snail Mail
Emergency Contact Name
*
This must be someone different than a parent
First Name
Last Name
Emergency Contact Phone
*
(###)
###
####
Relationship to Child
*
Checkbox(I), (We) the undersigned parent(s) of the child mentioned above, a minor, do hereby authorize Westminster Presbyterian Church’s children’s ministry leaders as agents for the undersigned to consent to any x-ray examination, anesthetic, medical or surgery diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any physician and surgeon licensed under the provision of the Medical Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or at a hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required, but is given to provide authority and power on the part of our aforesaid agents to give specific consent to any and all such diagnosis treatment or hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable. This authorization is given pursuant to the provisions of Section 25:8 of the Civil Code of California. This authorization is for all children’s ministry activities at Westminster Presbyterian Church.
By clicking the box below you are agreeing that the check box is the same as a digital signature.
(I), (We) the undersigned parent(s) of the 'child listed above', a minor, do hereby authorize Westminster Presbyterian Church’s children’s ministry leaders to photograph and video tape our child in an appropriate and tasteful manner. We realize that pictures may be used in slide shows, newsletters, the church web-site, and other church related uses. Video may also be used for publicity, activities, and other program related uses.
We, the parents of the ‘above mentioned child,’ shall indemnify, hold free and harmless, assume liability for, and defend Westminster Presbyterian Church and it’s affiliate corporations , its agents, servants, employees, officers, and directors from any costs and expenses including but not limited to, attorney’s fees, reasonable investigative and discovery costs, court costs, and all other sums which the Westminster Presbyterian Church may incur based on any assertion of liability, or any other claim or action founded thereon, arising or alleged to have arisen out of ‘the above mentioned child’ use of real or personal property belonging to Westminster Presbyterian Church and its affiliate corporations, its agents, employees, officers, and directors, or by action or omission by ‘the above mentioned child.’
*
By clicking the box below you are agreeing that the check box is the same as a digital signature.
