VBS 2019 Registration Form
First name of child (one response per child please)
Please enter child's first name
Last name of child
Please enter child's last name
Child's preferred first name
Please enter your child's preferred first name if different than above
Going to grade
Which school grade will your child will be attending in September?
What is your child's age?
Please enter your street address. Required only for youngest child entered.
Please enter your city. Required only for youngest child entered.
Please enter your postal code. Required only for youngest child entered.
Care Card number
Please provide your child's BC Care Card number.
Specify the name of the parent/caregiver of the child(ren) listed above.
Parent/caregiver home number
Parent/Caregiver cell phone number
Specify the cell phone number at which the parent/caregiver can be reached (if different from home).
Emergency contact name(If possible list someone other then the Parent/caregiver already named).
Specify the name of the person who should be contacted in case of emergency.
Emergency contact number
Specify the phone number at which the emergency contact can be reached.
Relationship of emergency contact to you
Specify how you know the emergency contact.
Does your child have any allergies or dietary restrictions? Please list.
Anything else we need to know?
How did you hear about us?
To help direct future advertising efforts, we would appreciate knowing how you heard about us.
Attending Langley Canadian Reformed Church
Previously attended VBS
Received a flyer
Recieved a postcard in the mail
Sign on the road
Do you have a Bible at home?
Name of home Church, if any?
If you regularly attend a Church, please let us know which one.
May we use pictures of your child(ren) for informational or promotional purposes?
Yes, I give consent
No, I do not give consent
A copy of your responses will be emailed to the address you provided.
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