EXCELSIOR SPRINGS NAZARENE 2025 VACATION BIBLE SCHOOL REGISTRATION FORM

Jun 16 to 20, 2025, from 6 to 8 p.m. each night | Excelsior Springs Church of the Nazarene
1308 Tracy Avenue
Excelsior Springs, MO 64024
www.esnazarene.org

Please fill out and Submit one form per child.

Basic Information

Child's First Name

Child's Last Name

Child's Date of Birth

Child's Age

Child's Grade Level This Fall

Please select one option.

Kindergarten 1st 2nd 3rd 4th 5th

Parent/Guardian's Name

Relationship to Child

Address

This address will receive a confirmation email

Phone

Emergency Contact Information

Emergency Contact Name

Relationship to Child

Emergency Contact Phone Number

Medical Information

Allergies (food, medications, etc.)

Medical Conditions

Additional Information

Home Church, if applicable

Names of Siblings Attending, if applicable

Authorized Pickup Person(s)

Additional Info or Special Instructions

Permissions and Agreements

PHOTO RELEASE: Do you give permission for photos of your child to be used for church publications and social media?

Please select one option.

Yes No

MEDICAL RELEASE: Do you authorize the church to seek medical treatment for your child in case of emergency?

Please select one option.

Yes No

Signature

By signing this form electronically below, you do hereby guarantee that you are a legally authorized parent or guardian to grant permission for your child to attend Excelsior Springs Church of the Nazarene's Vacation Bible School the week of June 16 through June 20, 2025.

Signature (Your electronic printed name represents signature)

Date of Signature

Description

Jun 16 to 20, 2025, from 6 to 8 p.m. each night

Excelsior Springs Church of the Nazarene
1308 Tracy Avenue
Excelsior Springs, MO 64024
www.esnazarene.org

Please fill out and Submit one form per child.

EXCELSIOR SPRINGS NAZARENE 2025 VACATION BIBLE SCHOOL REGISTRATION FORM

Description

Please Fix the Following