Vacation Bible School (VBS) Registration Form
Please complete one form for each child being registered for VBS
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  • Please identify above any specific health problems or facts concerning the child’s medical history about which we or a treating physician should be aware, such as allergies, allergies to medication such as penicillin, unusual reactions to insect bites, medications being taken, physical impairments, etc.
    If reasonable attempts to contact me have been unsuccessful in an emergency, I hereby give permission to St. Philip’s Episcopal Church Vacation Bible School to secure necessary emergency treatment including transport to a local hospital, and for any licensed physician or dentist to administer any treatment considered necessary. This authorization does not cover major surgery unless the medical opinions of two licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.
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  • Enter name(s) and telephone numbers above.
  • Type your first and last name in the above box indicating that you have read the statement above the box.
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