VBS - First United Methodist Church of Homosassa

"Around The World" Vacation Bible School

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Child's Age

Date of Birth

Grade

Child's Name

Parent/Guardian Name(s)

Home Phone

Address (street address, city, state, zip)

Parent/Guardian Phone

Home Email Address

Home Church

Allergies or other medical conditions

What are your child’s strengths? (Drawing, writing, encouraging, reading, attitude, social relationships...)
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What are some areas your child struggles with or needs your child has in this environment? (reading, writing, relating to others, sensory differences, focus and attention…)

T-shirt Sizes

Who is allowed to pick up the child?

Authorized Person 1*

Name

Home Phone

Work Phone

Cell Phone

Authorized Person 2

Name

Home Phone

Work Phone

Cell Phone

Authorized Person 3

Name

Home Phone

Work Phone

Cell Phone

Authorized Person 4

Name

Home Phone

Work Phone

Cell Phone

Photographs

Occasionally, for church purposes we may photograph various classroom activities or events. On occasion those photographs may be used for church bulletins, the church website, or Facebook page.

I GIVE MY PERMISSION for my child to have his/her picture published in the MediaI DO NOT WANT my child to have his/her picture published in the Media

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