VBS Registration Form : San Diego Clairemont Seventh-Day Adventist Church San Diego CA

Child #1

Child's Nickname

Child's Gender

Child's Age

Date of Birth

T-Shirt Size

Allergies/Medical Conditions

Any Special Circumstances We Should Be Aware Of?(special needs or disabilities, and/or specific considerations). Yes No

Optional:

fill out the second page if you have selected "yes."

Child #2

Child's Nickname

Child's Gender

Child's Age

Date of Birth

T-Shirt Size

Allergies/Medical Conditions

Any Special Circumstances We Should Be Aware Of?(special needs or disabilities, and/or specific considerations).

Optional:

fill out the second page if you have selected "yes."

Child #3

Child's Nickname

Child's Gender

Child's Age

Date of Birth

T-Shirt Size

Allergies/Medical Conditions

Any Special Circumstances We Should Be Aware Of?(special needs or disabilities, and/or specific considerations).

Optional:

fill out the second page if you have selected "yes."

Name of guardian(s)

Address

Home telephone/Cell

Parent/guardian's cell phone

Home church

Custodial arrangement if applicable:

In case of emergeny, contact

Phone/cell

I give permission to call 911 in case of emergency

Yes No

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

Yes No

Optional: Special Needs Survey

Please fill out this survey only if you selected "yes" to Special Needs on the Registration Form. We are excited to have your child here at VBS! We believe that every child has God-given strengths and abilities. We would love to get to know your child better in order to encourage these strengths and abilities as well as to support them in the areas where they may need additional help. Please fill out the forms below so that we can get to know your child better.

Child Name

Parent's Name

My child has the following educational label or medical diagnosis:

My child's primary means of communication is:

Additional information concerning my child's allergies or food sensitivities:

My child's favorite activities and interests are:

My child avoids doing or becomes easily frustrated with the following activities:

If my child becomes overwhelmed or frustrated they will respond best to:

My child's strengths are:

My child needs help with:

What suggestions do you have that may help us create the best possible experience for your child?

What information would you like us to share with other children at VBS that will help them to better know, accept and understand your child?

San Diego Clairemont Seventh-Day Adventist Church

Developing a loving relationship with Christ and our community