VBS 2019 Celebrating God's Earth
Join us at the United Church of Cookeville for a week of learning, exploring, creating, given, and saving the creation as we have tons of fun Celebrating God’s Earth.

Please complete a separate form for each child participating.

VBS is FREE for everyone, with Afternoon Fun (extended care) only $5 per day per child. Lunch is brownbag and NOT included in the cost (i.e. please provide lunch for your child).
Email address *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Date Of Birth *
MM
/
DD
/
YYYY
Full Address *
Street, City, State, Zip Code
Your answer
Parent/Guardian Name *
First, Last
Your answer
Primary Phone Number *
xxx-xxx-xxxx
Your answer
Additional Parent/Guardian Name
First, Last
Your answer
Additional Phone Number
xxx-xxx-xxxx
Your answer
Emergency Contact (In addition to parent/guardian) *
First Name, Last Name
Your answer
Emergency Contact Phone Number *
xxx-xxx-xxxx
Your answer
Allergies? *
Yes or No. If Yes, please explain
Your answer
Will your child attend Monday, July 8? *
Check all that apply.
Required
Will your child attend Tuesday, July 9? *
Check all that apply
Required
Will your child attend Wednesday, July 10? *
Check all that apply
Required
Will your child attend Thursday, July 11? *
Check all that apply
Required
Will your child attend Friday, July 12? *
Check all that apply
Required
Photo Release *
I agree that any photographs taken of my child during this event are the property of the United Church of Cookeville and may be used in future publications as deemed appropriate
A copy of your responses will be emailed to the address you provided.
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