Vacation Bible School Registration
Wednesday through Friday June 14-16, 6:00-8:00 PM. A light dinner will be served each evening.

Please complete a form for each child.

Student's Name
Your answer
Age
Your answer
Grade Entering
Home Church (if applicable)
Your answer
Allergies
Your answer
Medical Issues or Special Needs
Your answer
Address:
Your answer
Phone: Home & Cell
Your answer
Email
Your answer
Emergency Contacts (Name & Phone)
Your answer
Is there any additional information we should know?
Your answer
Medical Release: I, the parent/guardian, give my permission for VBS staff and volunteers to administer basic first to my child (named above) in the event of injury. I understand that the VBS staff and volunteers will contact the parent/guardian and emergency services in the event of a significant injury and all expenses for such emergency treatment will be the parent/guardian's responsibility.
Permission to Attend: I, the parent/guardian, give permission for my child (named above) to attend the Vacation Bible School (VBS) hosted at Cornerstone Presbyterian Church. I understand that the information I give for this registration will only be used by Cornerstone Presbyterian Church for the purposes of this VBS event.
If you agree to the Release and Permission statements, please sign using your full name:
Your answer
T-Shirt Size
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