VBS Registration 2017
June 19 - 22, 2017 from 9:00 am - 12 pm
Monday - Thursday
Closing Celebration Picnic Thursday, June 22 at Noon
Child's Last Name:
Your answer
Child's First Name:
Your answer
Grade Just COMPLETED:
Birthday:
MM
/
DD
/
YYYY
Age:
*Student must be 4 years old by September 30, 2017 to attend.
Your answer
Do you plan to join us for the celebration picnic on Thursday at Noon? (Closing ceremony at 11:30am)
Parent/Guardian:
Your answer
Parent/Guardian's Phone Number:
*Please include number(s) where you can be reached during VBS hours!*
Your answer
Parent's E-mail Address:
Your answer
Mailing Address:
Your answer
Emergency Contact Information:
*Please include Name, Relationship, Contact Number(s)*
Your answer
Allergies:
*Please type none, if there are no known allergies*
Your answer
Medical Conditions/Special Needs/Other important information the child's teacher needs to know:
Your answer
By typing your name below, you release adult supervisors and Faith Presbyterian Church, Clinton, LA. from responsibility for accidents during church sponsored activities. In case of emergency, I, the parent/legal guardian of the above mentioned minor, give permission to the adult sponsors of Faith Presbyterian Church, Clinton, LA. to secure proper treatment for the health and comfort of my child until I can be reached.
Your answer
By typing your name below, you give permission to Faith Presbyterian Church, Clinton, LA. to photograph and video record my child at Vacation Bible School. I give permission to copyright, use, and publish the photographs and video for any lawful purpose, including newspaper articles, church publications, and the church website.
Your answer
Invited to VBS by:
Your answer
Home Church:
Your answer
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