Request edit access
St. David's VBS 2019
June 17-June 21st
St. David's Episcopal Church
43600 Russell Branch Pkwy
Ashburn, VA 20147
vbs@sdlife.org
VBS Camp 2019 - PLEASE COMPLETE ONE REGISTRATION FORM PER CHILD. Thank you!
Child's Last Name *
Your answer
Child's First Name *
Your answer
Parent/Guardian Name (s) *
Your answer
Address *
Your answer
Email *
Your answer
Phone Numbers: How can we reach you?
Cell Phone
Your answer
Home Phone
Your answer
Work Phone
Your answer
Age Information: VBS camp is intended for children age 4 (by September 30, 2019) through rising 6th grade.
Rising grade in school (2019-20). For preschool age children, please provide information on the class they will be in (4 yr, preK, etc) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Medical Information
Are there medical or other information we should know about your child? Please include any food allergies.
Your answer
If your child has an allergy, does he/she require the use of an Epi-pen? NOTE: St. David’s VBS does not allow snack substitutions unless medically necessary.
Emergency Contacts/Dismissal Information
Emergency Contact # 1: Include name/numbers *
Your answer
Emergency Contact # 2: Include name/numbers *
Your answer
Dismissal Information: The following adults may take my children home. Include names/numbers. *
Your answer
Additional Information
Does your family attend St. David’s Episcopal CHURCH? *
Do you have a child enrolled at St. David’s Episcopal SCHOOL? *
Are you interested in volunteering for VBS? *
Child's t-shirt size *
I understand that no refunds will be given after May 1st. *
I understand that children attending St. David’s VBS may be photographed during the week. By registering for VBS, you are agreeing that we can use your child’s photo on the St. David’s web site and/or Facebook pages. No names will be used. *
I understand that I must submit a $45 payment to complete my registration. You may use the following link to make an online payment - https://www.eservicepayments.com/cgi-bin/Vanco_ver3.vps?appver3=Fi1giPL8kwX_Oe1AO50jRkzSsD8apWqCHMXGp5lsWDDHO3iVYxvvxhHjRfLOeq662EvVVAEjqawDomKT1pbouRBi8p8Pdpl9ciQ7_NFEcD0= You may also pay by check, payable to St. David's Church. Please put "VBS" in the memo section. *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service