Operation Arctic VBS 2019
Registration form for June 17-20, 2018 VBS -- Central Park Church, Park Church & Embody Christ Fellowship.
Held at Central Park Church - 614 Myrtle Avenue, Holland, MI 49423
Please fill out a separate registration form for each child
Email address *
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Address: Street *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Grade Child will start in September 2019 *
Parent/Guardian Full Name *
Your answer
Parent Phone Number *
Your answer
Parent Email Address
Your answer
Emergency Contact Name & Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
Does your child have any special needs (allergies, disabilities, etc.) which you would like us to know about as they participate in Operation Arctic VBS 2019?
Your answer
My child has permission to participate in Operation Arctic VBS 2019 I give permission for medical attention to be provided for my child in the event of accident or illness with the understanding that every effort will be made to contact me and the emergency contact at the above numbers. I also hereby release Central Park Church, Park Church & Embody Christ Fellowship, their staff and volunteers, of any and all liability for any loss, injury or property damage which may result while participating in Operation Arctic VBS 2019. *
Required
Pictures: I give permission for pictures of my child to appear in publications of Central Park Church, Park Church or Embody Christ Fellowship, including websites. Names would not be included in any publications. *
Required
A copy of your responses will be emailed to the address you provided.
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