Oneida Gospel Church Vacation Bible School (Final) • Oneida Gospel Church

You will be asked to sign the following waiver upon dropoff (link).

Child First Name *

Child Last Name *

Has this child ever attended VBS at Oneida? *

May Oneida use pictures of this child for future publicity? *

Yes

Gender *

Date of Birth *

School Grade [2024-2025] (only accepting incoming K-5th) *

Allergies

Additional Information

Is Oneida authorized to approve medical treatment? *

Yes

Is participant covered by personal/family medical insurance? *

Yes

Insurer Name

Medical Policy or Group #

Guardian Name *

Relationship

Other Authorized Pickup People

Guardian Email Address *

Guardian Mobile Number *

Address

City

State

Zip Code

Emergency Contact Name #1 *

Emergency Contact Mobile #1 *

Emergency Contact Name #2

Emergency Contact Mobile #2

You will review the child's contact, medical, and allergy information at our first meeting.