VBS : Klamath Falls Adventist® Christian School Klamath Falls OR

Vacation Bible School

August 11-15

6-8pm

Join us for a week filled with fun and learning more about Jesus!

Child #1 Name

Date of Birth

Child's Age

Child's Gender

Allergies or other medical conditions (i.e. diabetes)

Any special circumstances we should be aware of? (special needs or disabilities, and/or specific considerations).

Yes No

Child #2 Name

Date of Birth

Child's Age

Child's Gender

Allergies or other medical conditions (i.e. diabetes)

Any special circumstances we should be aware of? (special needs or disabilities, and/or specific considerations).

Yes No

Child #3 Name

Child's Age

Date of Birth

Child's Gender

Allergies or other medical conditions (i.e. diabetes)

Any special circumstances we should be aware of? (special needs or disabilities, and/or specific considerations).

Yes No

Name of guardian(s)

Address

Phone

Home Church

Custodial arrangement if applicable:

In case of an emergency contact:

Emergency Contact Phone #:

Relationship to child(s)

Parent/guardian signature:

Date

Photographs will be taken during VBS. Do you give permission for your child’s photo to be taken?

Yes No

Klamath Falls Adventist^® Christian School