Dr. Seuss VBS Registration
Registration for Dr. Seuss VBS this summer June 17-21 2019.

9:00am-12:00pm (noon)

$35 per child *$75 for families of 3 or more*

Follow this link to submit payment & select "VBS" from the drop-down (will open in separate window): https://onrealm.org/ColumbineUnited/Give/NYILUBIHNC

Email address *
Child's Name *
Grade Entering Fall 2019 *
Child's Allergies *
Parent/Guardian Name *
Street Address *
City *
Zipcode *
Parent/Guardian Phone # *
Emergency Contact *
Emergency Contact Phone # *
Relationship to Child
Clear selection
Home Church
I heard about Dr. Seuss VBS through
Clear selection
*Our philosophy is to not put kids with their friends so they can meet other kids and make friends at camp. However, if there are extenuating circumstances, we will do our best to accommodate your child. Please provide information below:
I understand that I will have to pay $$ before 06/01/2019 to reserve my child's spot *
**I give permission for my child's photo(s) to be used on the CUC website of Facebook page. No names or personal information will be shared other than the photo itself. * *
Parent/Guardian Signature *
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