2020 VBS Registration Father's Name First Last Mother's Name First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone Number (Father)Daytime Phone Number (Father)Cell Phone Number (Mother)Daytime Phone Number (Mother)Parents' Email Alternate Pickup ContactName of Pickup Contact (If different from parents listed above) First Last Home Phone Number (Pickup Contact)Cell Phone Number (Pickup Contact)Child 1 - Registration & Medical InformationChild's Name First Last Age Year In School (2020/2021) Gender Male Female Allergies Pollens Medications Food Insect Bites Other Elaborate on Possible AllergiesHas this child suffered from, experienced, or is being treated for: Asthma Heart Trouble Frequently Upset Stomach Epilepsy/Seizure Disorder Diabetes Physical Handicap Please ElaborateHas the child had any major illnesses in the past year? If so, should the child's activities be restricted in any way?Child 2 - Registration & Medical InformationChild's Name First Last Age Year In School (2020/2021) Gender Male Female Allergies Pollens Medications Food Insect Bites Other Elaborate on Possible AllergiesHas this child suffered from, experienced, or is being treated for: Asthma Heart Trouble Frequently Upset Stomach Epilepsy/Seizure Disorder Diabetes Physical Handicap Please ElaborateHas the child had any major illnesses in the past year? If so, should the child's activities be restricted in any way?Child 3 - Registration & Medical InformationChild's Name First Last Age Year In School (2020/2021) Gender Male Female Allergies Pollens Medications Food Insect Bites Other Elaborate on Possible AllergiesHas this child suffered from, experienced, or is being treated for: Asthma Heart Trouble Frequently Upset Stomach Epilepsy/Seizure Disorder Diabetes Physical Handicap Please ElaborateHas the child had any major illnesses in the past year? If so, should the child's activities be restricted in any way?Photo ReleaseI hereby grant Mt. Calvary Church permission to use photographs/videos taken of the minor(s) designated above in any manner or form for any purpose lawful at any time. Yes No COVID-19To ensure safety of everyone we ask that those entering our facility are free of the following symptoms that are related to the COVID-19 virus: Fever, Chills, Cough, Shortnes of breath, Muscle aches, Sore throat, New loss of sense of smell and taste. We ask you to maintian proper social distancing from others, wash hands, use hand sanitizer, and cover your mouth and nose when sneezing or coughing. An inherent risk of exposure to COVID-19 exists where people are present. By signing I understand that I voluntarily assume all risks related to exposure to COVID-19. Medical ReleaseMedical Release I give my permission for VBS staff to administer basic first aid to my child(ren) (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me. Permission to AttendPermission to Attend I give permission for my child(ren) (named above) to attend the Vacation Bible School (VBS) listed above. I understand that the information I give for this registration will only be used by the VBS hosting church.Signing Parent/Guardian First Last Date MM slash DD slash YYYY Δ