2018 Shipwrecked VBS and Wild Island Extended Day Camp Registration
(One form per student)

We are so excited for VBS this year!! You will see many new things added to the day and week for you and your family! Please note that VBS will now go from 9am to 12:30 with the choice to sign-up for our extended camp program; Wild Island Kidz! We also have a fun morning the Saturday before VBS so that you and your campers can decorate their VBS shirts!!

Email address *
Shipwrecked- Rescued by Jesus!
Camper's FIRST Name: *
Your answer
Camper's LAST Name: *
Your answer
Grade Entering Fall 2018: *
Date of Birth: *
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Gender: *
Special Needs or Allergies: *
(If your child has neither please write "none") If your child has any allergy or special needs listed here you will receive an email shortly with another form that needs to be completed.
Your answer
Street: *
Your answer
Town: *
Your answer
State: *
Your answer
Zip: *
Your answer
Parent/Guardian's Name (1): *
(First and Last Name)
Your answer
Email: *
Your answer
Confirm Email Address *
Your answer
Home Phone: *
Your answer
Cell Phone: *
Your answer
Work Phone:
Your answer
Parent/Guardian's Name (2):
(First and Last Name)
Your answer
Email: If they would like to be contacted too:
Your answer
Home Phone:
Your answer
Cell Phone:
Your answer
Emergency Contact: *
(Full Name)
Your answer
Emergency Contact Phone Number *
Your answer
Home Church *
Your answer
Specific Crew/Friend Request: *
Enter "none" if no requests.
Your answer
T-Shirt Size- Must be registered by June 15th to be guaranteed a shirt. Please choose "NONE" if you plan to use your own white shirt. *
New to VBS
Will you be attending our Tie Dye Event Saturday, June 23rd from 9am-12pm. NO EXTRA COST? *
Cost: *
Includes t-shirt. $40.00/child or $100.00/max per family. If after June 15th: $45.00/child or $115.00/max per family. Select one or more of the following options:
New This Year.....
Wild Island Kidz (Extended Day Camp)12:30-4pm. Please choose your days here ($75 for the week or $15/ day). *
All 5 Days
Monday
Tuesday
Wednesday
Thursday
Friday
NONE
Please choose your days here!
Wild Island Extended Day Camp Total per camper *
CDs: *
CDs are available for purchase and may be picked up at the office after May 30th or on the first day of VBS.
1 CD
2 CD's
3 CD's
4 CD's
More than 4? Please email ncobb@orchardnh.org
No, I'm all set, thank you!
How many would you like? Cd's are $10 each.
Total Payment Due: *
Please include all registration fees here and CD totals. Example: VBS, Wild Island for the full week, and a CD is $125 If you are paying under another registration type (0)
Your answer
PAYMENT: *
Please indicate form of payment
Paid under:
If you clicked "paid with another registration" please tell us the camper's name under which it was paid:
Your answer
Payment Agreement: *
By checking the box below you agree that your child does not have a reserved spot at VBS until payment has been recieved.
Required
Waiver: *
By typing below - I /We give permission for my child to participate in the 2018 Shipwrecked VBS this year. I/We give permission for The VBS staff to administer first aide as needed (for cuts, scrapes, etc.) and to seek further medical attention if needed. I/We hereby hold the VBS staff and sponsoring organization(s) as well as its representatives, harmless in the exercise of this authority. I/We also agree to allow my/our child to be photographed or videotaped by the VBS staff throughout the week. Please sign FULL NAME.
Your answer
Date: *
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Don't have a home Church? Let us know if you are interested in more information about Orchard Christian Fellowship or Londonderry Christian Church!
Your answer
Will you be able to join us for VBS Sunday at The Orchard on July 1st at 10am? This will be a combined service of LCC and OCF *
Here's what you can look forward to this year!
A copy of your responses will be emailed to the address you provided.
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