VBX Registration : Rutland Seventh-day Adventist® Church Kelowna BC

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VBX Registration

For more information email vbs@rutlandadventist.ca!

All information collected is stored with the Rutland Seventh-day Adventist Church and is only used for Vacation Bible Xperience. No information will be sold or given out to any outside organization or company.

Child's Name

Gender Male Female

Child's Age

Child's date of birth

Name of parents/guardians

Address

Phone

Custodial arrangement if applicable

How did you hear about this year's Vacation Bible Xperience?

Child's allergies or other medical conditions

In case of emergency, contact

Phone

Relationship to child

I give permission to call 911 in case of emergency. Grant Do not grant

I hereby grant/do not grant permission for Rutland Seventh-day Adventist church to use pictures/videos of my child on their website and in church for informational or promotional purposes. Grant Do Not Grant

Signature

signature will be taken at VBX

SPECIAL NEEDS

If you would like to share any information regarding your child’s special needs, please fill out the second page of this form.

SPECIAL NEEDS SURVEY

We are excited to have your child here at VBX! We believe that every child has God-given strengths and abilities. We would love to get to know your child better in order to encourage these strengths and abilities as well as to support them in the areas where they may need additional help. Please fill out the form below so we can get to know your child better.

My child has the following educational label or medical diagnosis

My child has a support worker

Yes No

Support worker's name

My child’s primary means of communication is

Additional information concerning my child’s allergies or food sensitivities

My child’s favourite activities and interests are

My child avoids doing or becomes easily frustrated with the following activities

If my child becomes overwhelmed or frustrated they will respond best to

My child’s strengths are

My child needs help with

What suggestions do you have that may help us create the best possible experience for your child?

What information would you like us to share with other children at VBX that will help them to better know, accept and understand your child?

Rutland Seventh-day Adventist^® Church

in beautiful Kelowna, BC, Canada