Spirit Island: Ecumenical VBS Registration
August 5-9, 2019; 5:30-8:15 p.m.
Washington Avenue Christian Church
301 Washington Avenue
Elyria, OH 44035

Sponsored by: Washington Avenue Christian Church; Community of Faith UCC; and, First Congregational UCC

Child's First and Last Name *
Your answer
Grade (Completed)
Child's Age
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Parent/Guardian Email *
Your answer
Address *
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City *
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Zip Code *
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Preferred Phone *
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Alternate Phone
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Will someone other than the parent or guardian named above be picking up the child from VBS? *
If so, name of person and their relationship?
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Emergency Contact Name: *
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Emergency Contact Phone Number *
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Emergency Contact Relationship *
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Child's known allergies:
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Please list any medical conditions and medications taken:
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Primary care physician:
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Primary care physician phone:
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Preferred Hospital:
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Number of other children in your household attending?
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I give my permission for my child to be photographed and the images used for local and general church promotion in print and online. Your child will not be identified by name. *
To assist busy families, we will serve a Family Meal Monday-Thursday at 5:30 p.m. We hope that you will join us for dinner during the week. Please let us know how many family members will be joining us.
Your answer
On Friday evening, family and friends may join us for Pizza and an Ice Cream Sundae Bar. Please list the total number of people in your family who will join us. (Please include your child/children in this number. If you have more that one child attending this week, please only complete this question once.
Your answer
Home Congregation *
By selecting YES below, you agree to the terms listed above and that you have read the registration information regarding Spirit Island: VBS 2019. *
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