VACATION BILE SCHOOL STUDENT ON-LINE REGISTRATION FORM
. Please specify if your child will be going into Kindergarten in the Fall.
Child's Name:
Grade Completed:
Age:
Street Address:
City:
State:
Home Phone Number:
Work or Cell Number:
Email Address:
Invited By:
ALLERGIES/MEDICATIONS/SPECIAL INSTRUCTIONS
List all allergies:
Please list any physical,
emotional, or behavioral
concerns/limitations we
should be aware of:
EMERGENCY CONTACT INFORMATION
Emergency
Contact Name:
Relationship to your
child:
Contact Phone:
PARENTAL CONSENT AND MEDICAL RELEASE
In signing this document, I hereby certify that I give permission to my son or daughter to participate in
Vacation Bible School at
Crosscreek Park in Hilliard, OH sponsored by
Cornerstone Christian
Fellowship. I also authorize Cornerstone Christian Fellowship to use photographs, video, and audio
clips, including those of my son or daughter in camp publicity.
In signing this document, I give consent for my child to receive emergency medical care if I am unable to
be reached.
Parent or Guardian Signature
Date