VBC Registration
Stevens Road Baptist Church | 2 Stevens Rd., Dartmouth | srubcfamily@gmail.com | 902-435-1456
Important Information
Kids will Understand that Jesus is Their Rescuer

Music | Games | Bible Stories | Crafts | Missions | Snacks

Please register each child individually.
Be sure to choose the camp that suits your child best.

Week 1 - Gr. 1 - 5, July 9 - 13, 6pm - 8pm
We are trying something new this summer and providing an evening camp for our elementary age kids. We hope this will allow more families to participate.

Week 2 - Pre-School (3-5yr olds), August 13 - 18, 9am - 12pm
(3 yrs olds need to be turning 4 by the end of December and toilet trained)

Cost: Free for both camps!
Where: Stevens Road Baptist Church, 2 Stevens Rd., Dartmouth
Contact us at (902) 435-1456 or pastorerin@stevensroadbaptist.ca

Child's Information
First Name *
Your answer
Last Name *
Your answer
Which week is your child attending? *
What Grade or Age is your child? *
Please select what Grade child is entering in September 2018
Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian Information
First Name *
Your answer
Last Name *
Your answer
Address *
Street, City, Postal Code
Your answer
E-Mail *
Your answer
Phone Number *
Your answer
Cell phone Number *
Your answer
Emergency Contact Information *
Full Name, relation to child, and phone number
Your answer
Who will be picking up your child? *
If other then parent/guardian listed above, please provide full name and relation to child or bring a note for crew leader during week of camp.
Your answer
Do you have a Home Church? *
Required
If yes, where is your home church? *
Your answer
Photos and video's will be taken throughout the week of VBC. I hereby state that I grant permission for pictures and/or video of my son/daughter to be used in promotional material for Stevens Road Baptist Church use in promotional material and updates. *
How did you hear about VBC Shipwrecked? *
I understand that upon bringing my child to VBC the person dropping off and picking up my child will sign him or her in and out each day with his or her group leader. *
This is to ensure the safety of the child and also for the group leaders to get to know parents and/or guardians of the children in their groups. For Week 1 Children will start and finish the day in the church sanctuary. Please use door closest to Stevens Rd. For Week 2 Children will start of in the gym. Please use the "Office" door closes to Tacoma Rd.
The above registration form was read and completed by: *
Parent/Guardian Name
Your answer
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