VBS – Lifehouse

Lifehouse Assembly of God

July 19^th-21^st from 6 to 8:30 pm

Preschool-5^th grade

Must be able to use bathroom on their own.

Child's Name

Child's Age

Parent/Guardian Name

Parent/Guardian Address

Parent/Guardian Phone

Does the child have any medical conditions/allergies?

Yes No

If yes, please let us know what type:

If the child has a food allergy, will you provide a snack they are safe to have?

Yes No

Emergency Contact

Emergency Contact Phone

Relationship to child

Home Church

If you don't have a home church, may we contact you with information about our children's programs?

Yes No