Eastside Christian Church VBS Child Registration Form

Child Information

Child Name:

Grade (that the child was at the end of the past school year):

Toddler (3 y/o potty trained) Pre-K (4-5 y/o) Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Has your child attended a VBS at Eastside before?

Yes No

Will your child be attending all 5 days of VBS? If no, please list the dates your child will not be present.

How did you hear about our VBS?

Church (Sunday morning promotion) Parent Email School flyer Facebook Instagram Invited by a friend Milford Easter Egg Hunt The Amazing Chemistry Show Other

If invited by a friend, please give the name of the friend:

Parent/Guardian Information

Parent/Guardian Name:

Email:

This address will receive a confirmation email

Phone Number:

Address:

Do you currently attend Eastside Christian Church?

Yes No

Emergency Medical Release Form

Please fill out this out with the medical information of the child listed above. This is a release for Eastside Christian Church's VBS on June 15-19, 2026.

Age of child:

Gender of child:

Male Female

Is the address listed above under parent/guardian information the same address as the child?

Yes No

If no, please list the current address of the child:

Emergency Contact Name (other than parent/guardian listed above) and Relationship to Child:

Emergency Contact Phone Number:

Does your child have any allergies (food, medication, insects, etc.)? If yes, please list.

Does your child have any medical conditions or special needs? If yes, please list.

Medical Release and Authorization:
I, the undersigned parent or legal guardian of the above-named child, authorize the staff and volunteers of Eastside Christian Church to obtain any necessary medical treatment for my child in the event of an emergency. I understand that every effort will be made to contact me or the emergency contact listed above before such action is taken.
I hereby release and hold harmless Eastside Christian Church and its agents, employees, and volunteers from any liability or illnesses sustained during VBS activities. I assume full financial responsibility for any medical treatment provided.

Signature of parent/guardian:

Date Signed:

Do we, Eastside Christian Church, have permission to photograph and/or video record content that may include your child during VBS activities to use in church publications, social media, or presentations?

Yes No

Eastside Christian Church VBS Child Registration Form

Description

Please Fix the Following