Dewitt Community Church 2018 Vacation Bible School Registration August 13-17, 9 AM to 12 PM
Venture onto an uncharted island where kids survive and thrive.
Anchor kids in the truth that Jesus carries them through life’s storms.

Please bring your child between 8:45 and 9:00 each day to ensure a smooth transition at drop-off.

Cost is $25 for one child, $50 for two children or more than two children.
Programs are available for toddlers through pre-K, and Grades K through 5

Please contact Ben Rayland (315-445-0331, brayland@dewittchurch.org) if you have any questions.

Your Child's Information
(Please use an additional form for any additional children who will be attending VBS. Thanks!)
First Name *
Your answer
Grade *
Your answer
Home Address *
Your answer
Special Needs/Other Information
e.g. death in the family, condition, illness, disability, requests to be with siblings/friends, etc.
Your answer
Age (As of August 13th) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Child's Allergies
Please list any allergies. Be specific and note anything that would help us ensure your child's health and well-being. If your child requires gluten-free food, you must send snacks with him/her each day. We will do our best to accommodate all food allergies during snack time.
Your answer
Parent/Guardian's Information
Name *
Your answer
Additional Phone Number
Your answer
Email Address *
Your answer
Cell Phone Number *
Your answer
Emergency Contact Information
This should be an adult other than the parent/guardian listed above.
Relationship *
Your answer
Name *
Your answer
Cell Phone Number *
Your answer
Other Information
Publicity Permission *
I give my permission for my child(ren) to be photographed for any church publicity purposes.
VBS Cost and Payment *
The cost below covers crafts, games, snacks, etc. If your family is unable to cover the entire amount, please contact the church about our scholarship program. Please mail check to Dewitt Community Church 3600 Erie Blvd. East, Dewitt, NY 13214. You may also drop off your check or cash payment in the church office.
Parent or Guardian's Electronic Signature *
Typing your name in the box below will serve as your electronic signature.
Your answer
Person(s) allowed to pick up my child *
Please include yourself, your spouse (if applicable), etc. Be specific, as we can only release your child to someone listed here.
Your answer
Disclaimer *
I will not hold DCC responsible should my child get injured while attending VBS.
Thank You for Registering!
We will be contacting you to confirm your registration.
How did you hear about our VBS?
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