CCR 2019 VBS Registration Form
This registration form is for Calvary Chapel Ridgecrest (CCR) Vacation Bible School (VBS)
June 10th - 14th, 2019 from 5:15pm to 8:30pm (Check-in starts at 5:00pm)

Get ready for a safari filled adventure with Roar: Life is Wild – God is Good! Vacation Bible School, coming to Calvary Chapel on June 10-14, 2019!

Student First Name *
Your answer
Student Last Name *
Your answer
Nickname
Your answer
Age
Your answer
Gender
Grade just finished
Home Church (if applicable)
Your answer
Food/Medical Allergies
Your answer
Medical Issues or Special Needs
Your answer
Parent Name (First and Last) *
Your answer
Parent Email *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone Number
Your answer
Cell Phone Number *
Your answer
Other Phone Number
Your answer
Emergency Contact (First and Last Name)
Your answer
Emergency Phone Number
Your answer
Alternative Pickup (First and Last Name)
Your answer
Alternative Pickup Phone
Your answer
General Information
Your answer
Media Authorization *
I hereby grant CCR permission to copyright and use photographs/videos taken at VBS of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.
Medical Release *
I give my permission for the CCR VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the CCR VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me. PARENT OR GUARDIAN TYPE NAME BELOW.
Your answer
Permission to Attend *
I give my permission for my child (named above) to attend the CCR VBS. I understand that the information I give for this registration will only be used by the CCR, and that all registration information will be kept private and confidential. PARENT OR GUARDIAN TYPE NAME BELOW.
Your answer
Date *
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