2017 VBS Camper Registration
One registration form per child, please.

Fee is $25 per child, $40 for two children, $50 for three or more children.

Please pay online: https://onrealm.org/ColumbineUnited/Give/NYILUBIHNC. (Link will open a new window.)

My child's age range is:
(Children will be placed in similar age groups: Preschool, K-1st, 2nd-3rd, 4th-5th)
Child's Name:
Your answer
Grade entering Fall 2017:
Your answer
Parent:
Your answer
Caregiver:
Your answer
Street Address:
Your answer
City:
Your answer
Zip Code
Your answer
Home Phone:
Your answer
Parent or Caregiver Cell Phone:
Your answer
Home Email Address:
Your answer
Allergies or other medical concerns:
Your answer
Emergency Contact:
Your answer
Emergency Contact Phone:
Your answer
Emergency Contact's Relationship to Child:
Your answer
Home Church:
Your answer
I heard about VBS through:
Your answer
Our philosophy is to not put kids with their friends so that they can meet new friends during VBS. However, if there are extenuating circumstances, we will do our best to accommodate your child. Please provide information below:
Your answer
I give CUC permission for my child(ren)'s photo(s) to be used on the CUC website or Facebook page. No names will be used.
Please type your name below if granting permission.
Your answer
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