2018 Northminster Vacation Bible School Registration
Please fill out one form per child
Ages 3-5th grade
Monday, June 18-Thursday, June 21
Time: 9-11:30 a.m. (snack provided)
Location: 1416 20th St. Ames, IA

Join us for the VBS program on Thursday, June 21 @ 7 p.m. Snacks provided!

Please contact amesnpc@gmail.com or call 515-233-2540 with questions.

First and Last Name of Child: *
Your answer
Birth date of Child: *
Last grade of school completed: *
Your answer
Please list any allergies, medications, and/or other health conditions leaders should be aware of: *
Your answer
First & Last Name of Parent: *
Your answer
Parent Cell Phone Number: *
Your answer
Parent E-mail Address: *
Your answer
First & Last Name of Emergency Contact (not parent): *
In the event of an emergency, parents will be contacted first. Please list the name and number of the second person to call if you are not available.
Your answer
Emergency contact relationship: *
(grandparent, friend, aunt, etc.)
Your answer
Phone Number of Emergency Contact (not parent): *
Your answer
Name & Phone Number of Pediatrician: *
Your answer
Name & Phone Number of Dentist: *
Your answer
In the event of an emergency, I authorize provision of emergency treatment for my child (name listed above). If you are unable to contact me or the appropriate doctors (listed above), I give my consent for a medical professional and/or dentist to give necessary emergency medical treatment. I do hereby agree to indemnify and hold harmless the Northminster Presbyterian Church and the adult leaders from any and all actions, claims, demands, suits and/or other liabilities which may result from the above-named minor’s activities. *
I understand that my submitting this form, Northminster Church has my permission to use any pictures taken of my child at Vacation Bible School 2018 on their website or as needed. *
I am interested in volunteering at Vacation Bible School: *
there are multiple shifts and days available. You do not have to volunteer the entire week if you are not available.
My family plans to attend the VBS program on Thursday, June 21 at 7 p.m. :
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