Page 21 | Community Lighthouse Church of God

Name (Required)

Email Address (Required)

Primary Parent/ Guardian Full Name (Required)

Primary Parent/Guardian Phone Number (Required)

Primary Parent/Guardian Email (Required)

Secondary Parent/Guardian Full Name (Required)

Secondary Parent Phone Number (Required)

Home Address (Required)

Child/Children’s Full Legal Name (Required)

Date of birth (Required)

Does your child(ren) have any food sensitivities/allergies? (Required)

Dinner is served nightly during VBS

Does your child(ren) have any non-food allergies? (Required)

Please list emergency contact name, phone number, relationship to child in the event both legal guardians are not available. (Required)

Will someone other than the legal guardian be dropping off/picking up your child(ren) from VBS? Please give name and relationship to child(ren). (Required)

Do you give C.L.C.O.G. permission to post photographs your child(ren) on church social media? (Required)

We will be posting pictures on the church website and Facebook.

I understand the drop off and pick up policy. (Required)

I understand that only Community Lighthouse Church of God volunteers are permitted to stay on property other than drop off/pick up times and closing ceremony. This is for the safety of our students and volunteers. If your child has a medical condition that a parent needs to be present please contact the leader of VBS, Mallory Prince, prior to VBS by calling the church phone at (513) 984-5044.

I understand that my child(ren) are expected to follow the VBS rules. (Required)

If my child doesn’t follow expectations the VBS leader will follow this steps in addressing my child. 1. Verbal warning 2. Five minutes sit out 3. Call to parents

Does your child need transportation by C.L.C.O.G. van? (Required)

Must be within a 3 mile radius

I understand the following. (Required)

I understand that my child(ren) will be under adult supervision. I further understand that in signing this permission slip, I release and hold harmless Community Lighthouse Church of God staff and volunteers from any liability past or future, fully and completely.

Authorized to Treat Minor (Required)

In the event that I cannot be reached in an emergency, I hereby permit the staff and volunteers to call 911 and/or to contact a medical facility or physician selected by the church to provide proper treatment to the above named child(ren) and that I will be responsible for all expenses arising and associated with such treatment.

By completing this form and signing your name below, you are giving permission for your child(ren) to attend VBS 2025 at Community Lighthouse Church of God. (Required)

Would you like to receive information about upcoming events? (Required)