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VBS Registration Form
Thank you for registering your child for Some Assembly Required 2018!
Our VBS will be held Wednesday, July 18 - Friday, July 20, from 6:00 pm - 8:00 pm
A child must be 2 years of age to attend VBS. Children who have completed 6th grade can attend.

Please join us on Sunday, July 22 for our VBS Finale and picnic on the grounds.

Thanks again for taking the time to register! Note that each child must be registered on a different form.

Questions? Contact Laura Lord, Director of Children's Ministries at lauramlord@gmail.com or 319-538-1302

(NOTE: Please use the TAB key to move to the next field. If you press ENTER by mistake, once you move past the required fields, you will not be able to complete the registration.)Please submit a separate registration form for each child attending VBS.

July 18-20 and July 22
Child's name *
Your answer
Child's date of birth *
MM
/
DD
/
YYYY
Child's gender *
Recent Grade Completed *
Your answer
Parent/Guardian's Name *
Your answer
Phone you can be reached during VBS *
Your answer
Email *
Your answer
Physical Address *
Your answer
Who is authorized to pick up your child *
Your answer
Please list any dietary needs: *
Your answer
Please list any allergies, special need requests or medical conditions we should be aware of: *
Your answer
Emergency contact name *
Your answer
Emergency contact phone number *
Your answer
Emergency contact's relationship to child: *
Your answer
May we photograph your child for use on our website, facebook, etc. Names will NOT be used. *
In case of injury or illness, I authorize ConnectPoint church staff and volunteers to provide medical consent on my behalf, given that a reasonable attempt was made to contact me *
Is your child/family a member of a local church?
If yes, what church name?
Your answer
Any additional information we should know?
Your answer
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