Request edit access
VBS Registration 2017
Please use this form to register your child(ren) for Vacation Bible School.

Dates: June 26th-30th
Time: 9AM-11AM
Ages: 3 years (potty-trained) through Kindergarten Graduates

Contact Information
Parent/Guardian Name
Your answer
Address
Your answer
City
Your answer
Zip Code
Your answer
Phone Number
Your answer
Alternate Phone Number
Your answer
Emergency Information
Emergency Contact Name
Your answer
Emergency Contact Phone Number
Your answer
Physician Name
Your answer
Physician Phone Number
Your answer
Safety Information
Consent
By completing and submitting this form, I give permission for my child(red) to participate in Vacation Bible School (VBS) at the First Congregational Church of Eaton/Ault (FCCEA) and any activities related to VBS. I also authorize VBS staff to obtain emergency medical treatment in my absence, and release the FCCEA, it's staff, and VBS leaders of all liability and claims. Please type your name below if you agree.
Your answer
Relationship To Child(ren)
Security: is there anyone who your child(ren) should NOT be released to?
Your answer
May we use pictures or video of your child(ren)?
If your child(ren) are in any of the pictures or videos that we take, do you grant us permission to use them for publicity, illustration, advertising or web content? No names will be used.
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms