VBS 2017 - Registration
Please fill out one form per child. Submit the information for one child, then return to the form to register for another child.
Child's Name *
(Last, First)
Your answer
Child's Date of Birth *
(mm/dd/yyyy)
Your answer
What grade is your child entering? *
Select from the drop-down menu below.
What size t-shirt does your child wear? *
Required
Contact Information
Family Address - Street *
Your answer
Family Address - City *
Your answer
Family Address - State *
abbreviation preferred - i.e. PA
Your answer
Family Address - Zip Code *
Your answer
Parent/Guardian Name (s) *
Last, First - Can list 2 parents here
Your answer
Parent/Guardian Phone Number *
Primary number to reach you at (xxx-xxx-xxxx)
Your answer
Parent/Guardian Phone Number
Other number you can be reached at (xxx-xxx-xxxx)
Your answer
Parent/Guardian Email Address
Your answer
We value your privacy! *
Please check one of the boxes below to let us know how you would like us to use your email address
Required
Emergency Contact *
Name other than parent/guardian
Your answer
Emergency Contact Phone Number *
Daytime phone number (xxx-xxx-xxxx)
Your answer
Who will be picking up your child at the end of each day? *
We understand that there may be a change between now and the week of VBS. Please use your best judgment. You will be able to change any responses when you drop off on the first day.
Your answer
How did you hear about VBS at Faith Church? *
If you heard about VBS through a friend, please provide their name in the section "Other."
Required
Medical Information
Allergies *
Please list any allergies your child may have here, or type "none." Also, please note that all children with food allergies will be provided for. We would prefer that outside snacks not be brought. Thank you!
Your answer
Other Medical Information *
Please list any other important medical information about your child here, or type "none."
Your answer
Medical Release Forms *
*Please download and complete a medical release form and bring it with you on the first day of VBS. (https://faithchurchpa.org/wp-content/uploads/2017/06/Medical-Release-Form.pdf). Additional copies will be available at the church.
Required
Electronic Signature
Please type your name below.
Your answer
Parental Consent *
By checking the box below I hereby give my consent for the child named above to participate in this program.
Required
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