CHILL - First Presbyterian Church Granbury

Child's Name

Male or Female

Address

Zip

Phone Number

Age

Birth Date

School Grade COMPLETED

Church Home

Father's Name & Phone Number

Mother's Name & Phone Number

Emergency Contact & Phone Number

Who can pick up this student & phone number?

Brothers & Sisters with age

During VBS I can be reached at: (with phone number)

Does the child have: (YES/ NO) If yes explain. Diabetes

Does the child have: (YES/ NO) If yes explain. Allergies

Does the child have: (YES/ NO) If yes explain. Ashthma

Church Birth media.

Does the child have any other medical condition or other concerns that the staff should know about?

I give my permission for my child's picture (no names) to be on the website, Facebook, and other social media. (Yes/ No)

How did you hear about our VBS program?

Announcements- Will be made in church, News & Notes, Website, Facebook, etc