Student Registration Form

Parent or Guardian Name:

Email:

This address will receive a confirmation email

Phone:

Address:

STUDENT INFO (Please complete 1 form per student.)

Name:

Phone:

Email:

This address will receive a confirmation email

Birthday:

Grade:

Instagram:

I agree to allow my student's name and/or photo to be used in parent communications, on the VM website, Instagram page or other social media platforms and/or in print.

Yes No

EMERGENCY CONTACTS

Name:

Phone:

Name:

Phone:

ALLERGIES

Please list all allergies:

Primary Care Physician:

Address:

Phone:

PERMISSION

I am granting permission for my student, named above, to participate in Youth Activities on and off campus at Vernon Mission Christian Fellowship. This permission will remain in effect until 12-31-2026.

I agree that a staff member may seek medical care for my student in an emergency. Parent or Guardian will be contacted as soon as possible in the event of an accident or injury.

I also agree to electronically sign this form by typing my full name and the date at the bottom of this form.

Signed:

Date:

Description

Please fill out this form and click submit.

Student Registration Form

Description

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