Unlocking the Book of revelation: bible prophecy conference

CHILD REGISTRATION FORM

Child's nickname:

Date of Birth:

Name of parent/guardian:

Street address:

City:

State:

Zip:

Parent/guardian's cell phone:

Parent/guardian's Email

Custodial arrangement if applicable:

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

In case of emergency, contact:

Emergency contact phone:

Emergency Relationship to child:

I give permission to call 911 in case of emergency?

Yes No

Photographs will be taken during VBS. I am giving permission for my child's photo to be taken and used for event advertising on social media and or local media outlets.

Yes No

Does your child have any special needs? If yes, please fill out the Special Needs Survey

Yes No

Braselton Seventh-day Adventist House of Prayer

My house shall be called a house of prayer

Unlocking the Book of revelation: bible prophecy conference

SPECIAL NEEDS FORM