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SSPC Summer Seaquest VBS 2019 Student Registration
Event Timing: Sunday, July 14th - Thursday, July 18th (6-8:30 PM)
Event Address: Second Street Presbyterian Church - 325 Second Street, Albemarle, NC 28001
Ages: 2 years old - 6th Grade
Contact us at 704-982-6824 for more information!
Student Name *
Your answer
Student Age *
Age as of July 14th, 2019
Your answer
Student Grade Completed *
Age as of July 14th, 2019
Student Birth Date (M/D/Y) *
Your answer
Student Address *
Street/City/State/Zip
Your answer
Regularly Attend Church?
If so, what church?
Your answer
Invited by?
Your answer
Parent / Guardian Names *
Your answer
Parent / Guardian Phone 1 *
Your answer
Parent / Guardian Phone 2
Your answer
Parents / Guardian Email *
Your answer
Emergency Contact's Name (other than parent) *
Your answer
Emergency Contact's Phone *
Your answer
Child's Doctor Name *
Your answer
Child's Doctor's Phone *
Your answer
Additional Known Conditions / Info
Any additional info on student.
Your answer
Food Allergies *
In case of a medical emergency*, I hereby give my permission to the physician selected by the VBS Director(s) to secure proper treatment and/or hospitalization for my child.
Parent E-Signature *
Type Full Name here to E-Sign
Your answer
*The VBS Director(s) will make every attempt to reach the parent/legal guardian listed, or the emergency contact given on your registration form.
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