SeaQuest VBS Registration Please fill out this form for each child attending. Child's Name*Child's Age*Please enter a number from 4 to 12.Grade in Fall 2019*Pre-K/4 or 5 yrs.Kindergarten1st2nd3rd4th5th6thThe grade your child will enter in August.Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address Street Address Address Line 2 City ZIP Code Regularly attend church?YesNoWhere do you attend church?Parent(s) / Guardian(s)*Contact Email* Enter Email Confirm Email Mobile or Best Phone Number*Work PhoneEmergency Contact Name (other than parent)*Emergency Contact Phone*Medical ReleaseDoctor's Name*Phone*Conditions / AllergiesPlease enter any known conditions, allergies, or other information we should know.In case of a medical emergency*, I hereby give my permission to the physician selected by the Sea Quest VBS Director(s) to secure proper treatment and/or hospitalization for my child.*I agree* The Seaquest Director(s) will make every attempt to reach the parent/legal guardian listed, or the emergency contact given on your registration form.Friday Night Cookout and ProgramYou are invited! Friday Evening following VBS (6pm) our VBS Campers will present their VBS program and we’ll have a cookout to close out the week. There will be plenty of food and games for all. Parents and families are welcome and encouraged to attend. How many will be attending the cookout Friday evening?Just an estimate is asked for so we plan enough food for all!Photo Permissions*Yes, photos of my child are fine for online use.No, please do not place recognizable photos of my child online or in social media postsWe understand not everyone wants photos of their children posted online. Please let us know your preference. If a photo contains your child and you do not want them identified, we will obscure their face or cut them out of the photo entirely if possible.