IPC Hebron VBS 2019 - Student Registration Form
Please fill one registration from for each child. There will be a $20 registration fee that will include a T-Shirt. You can pay by cash, check in person or using the online option at IPCHouston.com

In Christ
Rose Eapen, Jebin & Michelle Samuel
Email address *
Student First Name *
Student Last Name *
Student Gender *
Student Birthday *
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Grade Completed by Student *
Student T-Shirt *
Parent or Guardian Last Name *
Parent or Guardian First Name *
Relationship with Student Registered
Clear selection
Contact Number *
Student Church Affiliation
Clear selection
Does Student has any Allergies or Reactions? *
Please List Student's Allergies and Reactions (if any)
Parent Acknowledgement
I have legal custody of the child named above, a minor and have give my consent for him/her to attend events being organized by IPC Hebron, Houston, TX. If my child experience a medical situation, every effort will be made to contact the legal guardians first. In the event the legal guardians are not available and the child need medical attention, this consent form gives permission to seek whatever medical attention is deemed necessary and releases the church and it's staff of any liability against personal losses of named child. I understand that there are inherent risks involved in any ministry or event, and I hereby release the church, its ministries, employees, and volunteer workers from any and all loss or damage to person or property that may occur during the course of my child's involvement. In the event that he/she is injured and requires medical attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a licensed physician and/or hospital personnel designated by the church
VBS Registration Payment *
Today's Date *
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A copy of your responses will be emailed to the address you provided.
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