VBS -- 2019 -- Registration Form
First Presbyterian Church and St. Peter's Episcopal Church are working together to offer Vacation Bible School for children ages 4-11 (entering 5th grade). VBS will be held July 15-19, from 9am to noon each day. The program will be offered at First Presbyterian Church, 301 Highway 35 North. Please complete this form once for each child you would like to register.
Child's Name (first and last) *
Your answer
Sex *
Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Last Grade Completed *
Your answer
Name of Parents *
Your answer
Street Address *
Your answer
Mailing Address (if different from Street Address) *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
Allergies or Other Medical Conditions *
Your answer
Emergency Contact #1 - Name *
Your answer
Emergency Contact #1 - Phone # *
Your answer
Emergency Contact #1 - Relationship *
Your answer
Emergency Contact #2 - Name *
Your answer
Emergency Contact #2 - Phone # *
Your answer
Emergency Contact #2 - Relationship *
Your answer
Authorized Pick-up Person #1 - Name *
Your answer
Authorized Pick-up Person #1 - Phone # *
Your answer
Authorized Pick-up Person #1 - Relationship *
Your answer
Authorized Pick-up Person #2 - Name *
Your answer
Authorized Pick-up Person #2 - Phone # *
Your answer
Authorized Pick-up Person #2 - Relationship *
Your answer
Picture Release - By registering your child for Vacation Bible School (VBS) you are giving permission for your child to be included in photographs or videos taken. This also grants your permission for photos and videos to be uploaded to our website. Signature of Parent/Guardian (type your full name to sign this registration form and Picture Release): *
Your answer
Date Signed: *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This form was created inside of Aransas County ISD. Report Abuse - Terms of Service