VBS - North Olmsted!

July 21-25 | 6-8 PM | @ NOEFC

Child Information

First Name

Last Name

Gender

Female

Male

Age

Birthdate

Parent/Guardian Information

First Name

Last Name

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Emergency/Authorized Contacts

Is the primary emergency contact the same as the parent/guardian listed above?

Yes

No

Emergency Contact 1- First Name

Last Name

Phone Number

Emergency Contact 2- First Name

Last Name

Phone Number

Health Information

Are there any medical concerns or special needs we need to know?

Does your child have any allergies we need to be aware of?

Yes

No

Please describe your child's allergy and the reaction that occurs

What protocol should we follow in the event of an allergic reaction

Additional Information

Friend Request (if you are coming with a friend, what is their name? We cannot guarantee more than two friend requests)

Do you attend a church?

Yes

No

Where?

Do you have any other questions/comments?

We take photos during VBS for promotional purposes. I give concent to the usage of images taken during VBS to be used for any purposes as seen fit by "North Olmsted Evangelical Friends Church", "Elyria Friends Church", and "Faith Force Kids", should your child(ren) appear in any of them.

Yes, I give consent for pictures to be used

No, I do not give consent for these photos to be used

Signature