Parent First Name: Parent Last Name:
Street Address:
City: State: Zip:
Phone: Cell Phone:
email:
Number of children you are registering: 1 2 3 4 5 6 7 8 (if registering more than 5, submit this page twice)
Parent: on the first day you will need to sign the following:
I hereby give my permission for my child/children to participate in the 2008 VBS. I understand that in signing this permission form, I release and hold harmless the Evangelical Free Church of Yacolt, and its trustees, officers, employees, and any volunteers from any liability, past or future, fully and completely. I authorize the staff or designated medical professionals to administer emergency medical assistance if I cannot be reached.
Child 1: First Name Last Name:
Birthdate: 1 2 3 4 5 6 7 8 9 10 11 12 Month Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 Grade: Pre-School Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade In Fall Male Female
Medical Concerns:
Child 2: First Name Last Name:
Child 3: First Name Last Name:
Child 4: First Name Last Name:
Child 5: First Name Last Name: