VBS 2019 - To Mars and Beyond
Welcome to "To Mars & Beyond" Explore where God's Power Can Take You at CCFLA

Date : July 20, 2019
Time: 8:00 am- 4:00 pm

Ages : 3-14
Donation: $ 15/Child
First Timers: Free

Register now and guarantee your child's spot by completing this form below.

For questions, please contact Deng Blanco at vbs@ccfla.org / 909.815.4904

To Mars and Beyond
Child #1
Child's Name *
Your answer
Child's Date of Birth
MM
/
DD
/
YYYY
Child's Age *
Child's School Year Just Completed *
Child's Shirt Size (Youth Size) *
Child #2
Child's Name
Your answer
Child's Date of Birth
MM
/
DD
/
YYYY
Child's Age
Child's School Year Just Completed
Child's Shirt Size (Youth Size)
Child #3
Child's Name
Your answer
Child's Date of Birth
MM
/
DD
/
YYYY
Child's Age
Child's School Year Just Completed
Child's Shirt Size (Youth Size)
Child #4
Child's Name
Your answer
Child's Date of Birth
MM
/
DD
/
YYYY
Child's Age
Child's School Year Just Completed
Child's Shirt Size (Youth Size)
Parent / Guardian
Parent/Guardian Name *
Your answer
Address *
Your answer
E-mail Address *
Your answer
Phone (Home)
Your answer
Phone (Cell)
Your answer
Phone (Work)
Your answer
Home Church (if any)
Your answer
Friends of your child at this Church (if any)
Your answer
Special Needs/Allergies / Medical Information / Other
Your answer
Emergency Contact
Emergency Contact Name(s) *
Your answer
Emergency Contact Phone(s) *
Your answer
Emergency Contact Relation(s)
Your answer
Name(s) of person(s) who may pick up this child from VBS *
Your answer
Insurance
Insurance Company *
Your answer
Policy Number *
Your answer
Consent
Photo/Video Release *
Required
By typing my initials below, I give permission for my child/ren to participate in classes and/or activities at CCFLA. I hereby authorize the volunteers and staff to administer emergency medical first aid treatment or to call for emergency services. *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Christ's Commission Fellowship Los Angeles. Report Abuse - Terms of Service