VBS Application – DPC Vacation Bible School

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Child Information

Child's First Name

Please enter the first name of the child who will be attending VBS

Child's Last Name

Please enter the last name of the child who will be attending VBS

Nickname if applicable

Date of Birth

Please enter your child's date of birth

Grade Completed (This School Year)

Gender

Does the child have any known allergies or medical conditions ?

Does the child have any dietary conditions ?

Does the child have any behavior conditions of we should be aware ?

Parent / Guardian Information:

Parent / Guardian Name(s):

Email Address:

Contact Phone Number:

Address

City

State

Zip

Emergency Contact Name:

Please enter someone addition to Parent / Guardian above

Emergency Contact's Phone Number

Relationship to child

Adults other than myself who are permitted to pick up my child from VBS (Photo ID will be required):

VBS Information

Has the child attended VBS before:

Child's Home church (if applicable)

How did you hear about VBS ?

Comments

Please tell us any other information that might be relevant to your child attending VBS

Permission and Release:

I hereby give permission for my child,

enter child's name here

to participate in all activities of the 2026 Darnestown Presbyterian Church Vacation Bible School.

I understand that I am responsible for ensuring my child has any necessary medications.

I understand that photos and videos may be taken during VBS activities and may be used for slide shows during VBS and for promotional purposes.

Signature

Clear Signature

Signer's Name

Date / Time