2019 CBCGL VBS Registration Form
Where: Chinese Bible Church of Greater Lowell, 197 Littleton Road, Chelmsford, MA 01824
Who: Children entering K - Grade 6 by September 2019
When: August 12th - 16th, 2019 9:00 A.M.to 3 P.M.
What: Roar! Life is wild, God is good.
Fee: $60 for the first child, $40 for each additional child. Check or cash must be received by July 14. Please mail or bring the payment to CBCGL at 197 Littleton Road, Chelmsford, MA 01824
Financial Aid is available. Please contact children.cbcgl@gmail.com for more details.
More questions? Please email children.cbcgl@gmail.com
Camper 1
Last Name *
Your answer
First Name *
Your answer
Birthday ( yyyy/mm/dd i.e. 2000/08/20 is August 20, 2000 ) *
Your answer
Gender *
Required
Camper 2
Last Name
Your answer
First Name
Your answer
Birthday ( yyyy/mm/dd, i.e. 2000/08/12 is August 12, 2000 )
Your answer
Gender
Parent/Guardian Information ( Emergency Contact )
Parent's Last Name *
Your answer
First Name *
Your answer
Email Address *
Your answer
Parent/Guardian Phone Number *
This is the main contact number and the emergency number that will be used during the VBS week.
Your answer
Allergies, Disability, Medication, or any other situation that needs attention during the week:
Your answer
Please enter Check Number for payment or enter “cash” if paid by cash. Please make the check payable to “CBCGL” and write “VBS, each child’s name, age” in the memo. Payment must be received by July 14. *
Your answer
Medical & Liability & Photo Release: In the event of sickness or some medical emergency, I request that my child receive any medical attention or treatment deemed necessary, therefore I give permission to any hospital, doctor, and/or health care provider to transport, treat and/or admit in order to care for my child. I understand that I am responsible for all expenses and charges for the treatment and care of my child. In the event that I am not present at the time of the emergency or cannot be contacted, my care has been entrusted to the staff and designated ministry leadership of Chinese Bible Church of Greater Lowell. I agree to hold Chinese Bible Church of Greater Lowell and its representatives harmless for any injury suffered during VBS. CBCGL reserves the right to use your child’s likeness in promoting the church either in print or online. As the parent/guardian of the child(ren) above, I hereby grant consent for him/her to participate in the field trip during VBS. *
Required
I consent and authorize CBCGL to copyright, use and publish any of the images in any format taken of the camper(s) listed above during VBS. I understand these images may be used for a variety of purposes and may appear on the website, social media, or any other media now known or to be invented. I also understand that CBCGL will use the images exclusively for CBCGL-related purposes and not for any commercial gain. Since anyone can download an image from the Internet or make copies from printed materials, I agree that CBCGL is not responsible for unauthorized use of the images. I am aware that I am not entitled to any compensation and that the images may appear with or without my or my club’s name. By signing below I acknowledge I have read and understand this release.
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