VBS 2017 Registration
We're super excited for VBS this year! It will be a great time of learning and fun for the young students.

THEME // Galactic Starveyors
MOTTO // Searching the Visible, Discovering the Invisible
THEME VERSE // "The Son is the image of the invisible God, the firstborn over all creation. For in him all things were created: things in heaven and on earth, visible and invisible, whether thrones or powers or rulers or authorities; all things have been created through him and for him.” (Colossians 1:15-16 NIV)

WHEN // 8/7 - 8/11 (M - F)
5 - 8:30 p.m. (Friday = VBS + Carnival)
WHERE // Berean Community Church
17911 Mitchell S,
Irvine, CA 92614
AGE // 3 yo (potty trained) ~ 5th grade
FEE // $30/child (T-shirt included)
**Free admission after 3rd child

REGISTRATION DATES // 7/2 (Sun) ~ 7/30 (Sun)
**If not registered by 7/30, no T-shirt.

Parent's Name
Your answer
Phone Numer
Your answer
E-mail Address
Your answer
Child's Name:
Your answer
Child's Age as of 9/1/17:
Child's T-shirt Size
Please notify us if you have special medical needs or conditions that require specific accommodation. Also notify our staff if you have medication/treatment restrictions or requirements in the event of a medical emergency or if you have a serious allergy.
Your answer
Medical Acknowledgement and Release
This aforementioned registration information and health history is true and correct to the best of my knowledge. I hereby give my full consent to Berean Community Church and its officers to seek and administer treatment for any injuries and/or illnesses that I might sustain while participating in the VBS activities and while under super- vision as a participant in said activities, including transportation to and from any facilities necessary for proper treatment. I understand that Berean Community Church will select a qualified physician, nurse, dentist, or other certified medical professional to administer treatment. As a participant, I understand that Berean Community Church is not obligated to carry any insurance to cover those medical and/or dental expenses. If such insurance is carried, coverage will be provided only for expenses in excess of the limits of the participant’s existing insurance coverage. I understand that my personal health insurance is my primary coverage for all occurrences while participating in VBS. In consideration of Berean Community Church providing these activities, I do hereby release Berean Community Church, its officers, employees, agents, and members from all claims and causes of action by reason of any injury or illness which may be sustained as a result of these church activities, whether on church premises or on the way to or from these activities. This authorization shall remain effective until revoked in writing and delivered to Berean Community Church.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms