Vacation Bible School 2026

Child's Name

Parent's Name

Parent's Phone

Family Email

This address will receive a confirmation email

Home Address

Child's Date of Birth (MM/DD/YY)

Child's Age

Grade Child is Entering

Does your child have any allergies ? YES or NO

YES NO

If YES, please explain.

Does your child have food restrictions?

Yes No

If YES, please name the food(s) your child is prohibited from eating. If we plan to serve an ingredient your child is prohibited from eating, we will contact you so you may provide a supplemental snack for your child.

Does your child have other behavioral, medical, or extenuating circumstances that the HPC staff should be aware of during their participation at VBS? YES of NO

YES NO

If YES, please explain.

Emergency Contact NAME #1 (Other than parent listed above)

Emergency Contact PHONE #1 (Other than parent listed above)

Emergency Contact NAME #2 (Other than parent listed above)

Emergency Contact PHONE #2 (Other than parent listed above)

EMERGENCY CONSENT AND RELEASE Should injury or other reason require immediate medical treatment with respect to the child named above, during any/all events, i hereby consent to such medical treatment as presented by a qualified physician. I also hereby release, acquit, and discharge Heritage Presbyterian Church, its staff and volunteers, from any and all injuries from whatever cause, which arise out of or are a consequence of any/all events that involve my child.

YES NO

PHOTO RELEASE I grant Heritage Presbyterian Church, its representatives and staff the right to take photographs or videos of my child named above. I authorize Heritage Presbyterian Church, its assignees and transferees to copyright, use and publish the same in print, and/or electronically. I agree that Heritage Presbyterian Church may use such photographs/videos of my child for any lawful purpose, including such purposes as publicity, illustration, advertising, and Web content.

YES NO

Vacation Bible School 2026

Description

Please Fix the Following