Child First Name Child Last Name Street Address or Box # City or Town Province Postal Code Email Address Birth Date of Child Sex of Child FemaleMaleSelect the grade the child is entering in the fall of 2025 KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Friend Request. Please list any other children your child may want to be placed in a class with. Although we can’t guarantee it, we will do our best to accommodate everyone’s requests. Please separate multiple names with a comma. Church you attend regularly (leave blank if none) Primary Contact Name Primary Contact Phone # Secondary Contact Name Secondary Contact Phone # Medical Needs / Allergies / Special Needs Do you give permission for your child to leave on their own after VBS is done for the day? YesNoIf you answered ‘YES’ to the previous question, you can skip the following question and proceed to the last question. Who do you authorize to pick up your child in addition to the Primary & Secondary stated above? Your child will not be released to unnamed persons not listed on this form. Please list the full legal name(s). Please separate multiple names with a comma. I agree that all information contained above is correct, and agree to abide by any policies that Osler Mission Chapel uses in the operation of VBS 2025. YesNo
