Community Church of East Gloucester 2019 VBS Registration
registration for the week of July 8 - 12
Camper 1: Name *
Please enter the camper's name
Your answer
What was Camper 1's grade in the 2018-2019 school year?
Does Camper 1 have any allergies or health concerns that we should know about? Please list or indicate N/A. Will any medications need to be administered while at VBS?
Your answer
Camper 2: Name
Please enter the camper's name
Your answer
What was Camper 2's grade in the 2018-2019 school year?
Does Camper 2 have any allergies or health concerns that we should know about? Please list or indicate N/A. Will any medications need to be administered while at VBS?
Your answer
Camper 3: Name
Please enter the camper's name
Your answer
What was Camper 3's grade in the 2018-2019 school year?
Does Camper 3 have any allergies or health concerns that we should know about? Please list or indicate N/A. Will any medications need to be administered while at VBS?
Your answer
Parent/guardian's name: *
Your answer
Parent/guardian's best contact phone number *
Your answer
Parent/guardian's email
Your answer
Parent/guardian's address
Your answer
Who has permission to pick up your child/children? Your child/children will only be dismissed to those named below: *
Your answer
Special request:
Your answer
I authorize and give my permission for my child/children to participate in Community Church's VBS program. I understand they may be participating in various activities outside and that there are risks associated with that. I give my consent to the use of any video or photography by the volunteers to share within Community Church, omitting names, and release Community Church from any liability connected with the use of multimedia in which my child appears. Please initial or sign below (I understand that typing my name electronically is the same as a signature): *
Your answer
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