Power Up VBS 2019-Child Registration
DATES: July 28-31, 2019--TIME: 5:30-8:00 pm--LOCATION: Journey Church, 61 Biesecker Rd, Lexington, NC 27295
Email Address *
Your answer
Child's Name (First) *
Your answer
Child's Name (Last) *
Your answer
What grade will your child be in this fall (2019) *
Child's Birthdate *
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DD
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YYYY
Child's Allergies & Health Concerns (Parents are responsible for making sure their child brings to VBS any needed supplies for their allergies or health concerns. Supplies may include, but are not limited to: EpiPen, inhaler, diabetic supplies, etc. It is also the responsibility of the parent to include this information on this form.)
Your answer
Parent/Guardian-Name (First and Last) *
Your answer
Parent/Guardian Address *
Your answer
Parent/Guardian Phone Number (include area code) *
Your answer
Emergency Contact-Name (First and Last) *
Your answer
Emergency Contact-Phone Number (include area code) *
Your answer
Transportation-Who will pick up your child from VBS each evening? (Children must be picked up no later than 8:10 pm each evening) *
Your answer
T-shirt size (We cannot guarantee t-shirts for kids registered after July 15, 2019.) *
I authorize the use of my child’s likeness and image to be used by Journey Church. (Journey Church Facebook and videos at Journey Church.) Child will have a colored sticker attached to their name tag if you request "no". No names will ever be used. *
Required
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