VBS 2023 Parent/Guardian Name* First Last Please list all names of children with their ages and completed grade level [1 per line]*Phone*Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Home Church Please list all allergies and medical information:*Please list 2 emergency contacts with their phone number:*How did you hear about VBS?Medical WaiverI give permission for my child to participate in classes and/or activities at River of Life Worship Center. I authorize the volunteers and staff to administer emergency medical first aid treatment, or to call for emergency medical response. (If no, parent will be required to stay with child at all times) Yes No Media ReleaseI give permission for my child's photograph/video to be used on the River of Life Worship Center's website and other social media outlets. Yes No CAPTCHA