Student Registration Form - CBC Vacation Bible School - Mystery Island 2021 (June 13-17)
Please complete a separate form for each child who will attend VBS. Some of the address information need only be entered once for the family/household (see instructions for those fields).
Email *
Child's First Name *
Child's Last Name *
Child's most recent school grade completed
Clear selection
Please select the evening(s) your child will eat dinner at the church
Parent/Guardian First Name *
Parent/Guardian Last Name *
Relationship to Child
Clear selection
Parent/Guardian Mobile Phone *
Street Address
You do not need to complete this field for multiple children living in the same household. Only complete for the FIRST child you register and we'll take care of the rest!
City
You do not need to complete this field for multiple children living in the same household. Only complete for the first child you register.
Zip
You do not need to complete this field for multiple children living in the same household. Only complete for the first child you register.
Name of an additional person we can contact in an emergency: *
What is that person's mobile phone number? *
What is that person's relationship to the child? *
Child's Allergies
Please list any allergies that your child has.
Child's Health Concerns
Please list any medical issues that the VBS staff should be aware of. (This information may be shared with VBS staff on a need-to-know basis.)
List the names of any other people who may drop off or pick up your child(ren)
Please affirm that you understand and agree with the following statement: *
Required
May we take photos or video of your child that may be used on the church's webpage(s), social media, and/or other types of media? *
Required
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