(574) 674-5918
• 58343 S Apple Rd, Osceola IN 46561 • info@osceolagrace.net
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VACATION BIBLE SCHOOL Registration Form
for Walk-ins
june 13-17
9am-noon
This form is for
Walk-ins being dropped off by parents or guardians.
If you want to register kids to ride the bus return to the main screen
and select the VBS Bus riders button.
All children must have completed kindergarten in order to attend. We are not providing a preschool program this year.
*
Indicates required field
Parent Name
*
First
Last
# of kids to register
*
Are you a VBS Volunteer?
*
YES
NO
If you are a part of our Osceola Grace church family and are scheduled to volunteer for Knight Tales then select "YES" here so we know you are coming and may register preschool kids.
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Additional Authorized Persons to pick up your child
*
Fill in names of any other people you authorize to pick up your child after VBS each day.
Email
*
Phone Number
*
Home or Cell - whichever is the best place to reach you!
Alternate Emergency Phone #
*
Not the same number as above - this is to reach someone if YOU don't answer.
Name of Church you currently attend:
*
If not attending a church enter N/A
Do any of the children you are registering have any special needs?
*
Yes
No
If you answer yes to this question, someone from the VBS staff will contact you to discuss our options of assisting your child.
If "Yes", please explain here
*
Please explain your child's special needs or IEP expectations. Thank-you for helping us know how to best serve your child.
Please NOTE: The Pre-school option is available here ONLY for our Volunteers who have Pre-school age children. We do not have a Pre-school program for Vacation Bible School.
Child's Name #1
*
First
Last
Birth Date #1 [mm/dd/yy]
*
Last Grade Completed #1
*
[select grade completed]
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Pre-School
Age
*
Food/Drug Allergies
*
Child's Name #2
*
First
Last
Birth Date #2 [mm/dd/yy]
*
Last Grade Completed #2
*
[select grade completed]
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Pre-School
Age
*
Food/Drug Allergies
*
Child's Name #3
*
First
Last
Birth Date #3 [mm/dd/yy]
*
Last Grade Completed #3
*
[select grade completed]
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Pre-School
Age
*
Food/Drug Allergies
*
Child's Name #4
*
First
Last
Birth Date #4 [mm/dd/yy]
*
Last Grade Completed #4
*
[select grade completed]
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Pre-School
Age
*
Food/Drug Allergies
*
Parental Consent Form
The undersigned does hereby give permission for the children listed on this electronic form to attend and participate in Vacation Bible School activities sponsored by the Osceola Grace Church for 2022.
My Authorization
I understand that in the event medical intervention is needed, every attempt will be made to contact the person(s) listed on this form. In the event I cannot be reached in an emergency, I hereby give permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or to order an injection, anesthesia, or surgery for my child as deemed necessary. I understand that my insurance coverage for my child will be used as primary coverage in the event a medical intervention might be needed. I understand all reasonable safety precautions will be taken at all times by the children’s staff of Osceola Grace Church’s Vacation Bible School. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Osceola Grace Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.
I understand that my child may be photographed or videoed for our church YouTube channel and internal church promotional purposes. No names will be publicized.
By submitting this form I agree to the above authorization.
Submit
