Hayworth Vacation Bible School 2026
Guardian Name
*
First Name
Last Name
Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Guardian Name-2
First Name
Last Name
Guardian Phone Number-2
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Child 1 Information
First Name
Last Name
Age of Child 1
Please Select
Infant
1
2
3
4
5
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11
Child 2 Information
Full Name
Age
Age of Child 2
Please Select
Infant
1
2
3
4
5
6
7
8
9
10
11
Child 3 Information
Full Name
Age
Age of Child 3
Please Select
Infant
1
2
3
4
5
6
7
8
9
10
11
Child 4 Information
Full Name
Age
Age of Child 4
Please Select
Infant
1
2
3
4
5
6
7
8
9
10
11
Child 5 Information
Full Name
Age
Age of Child 5
Please Select
Infant
1
2
3
4
5
6
7
8
9
10
11
Allergies/ Medical Information
*
Additional information helpful in caring for child/ren.
*
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
*
By checking here I, as the parent or legal guardian of the child(ren) listed above. Give permission for my child(ren) to participate in all activities at or sponsored by Hayworth Wesleyan Church. I understand that church staff and volunteers will take reasonable precautions to ensure safety. I release and hold harmless Hayworth Wesleyan Church, its pastors, staff, volunteers, and representatives from any liability, claims, or demands that may arise from my child’s participation in this event, except in cases of gross negligence or willful misconduct. I also give permission for basic first aid to be administered if necessary.
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