Kids Rock Registration

Thank you for registering for our Kids Rock program! Space is limited. You will receive confirmation of a space by email within one week of submission from neelsvillekids@gmail.com. Then, please mail in your check for the materials fee to hold your spot for Kids Rock Program Wednesdays 6:30-8:30pm include rehearsal for Jailhouse Rock, a children's musical, activity and craft station, outdoor games, snacks, and a Bible lesson.

Dates for Kids Rock program Nights are: July 11, July 18, July 25, August 1, August 8, August 15, August 22

Other Important dates:
August 18th & August 25th 10am-12pm Extra rehearsals
Performance: August 26th morning (time to be decided)

Optional auditions for children interested in speaking parts and singing solos is Saturday June 16th. See the webpage for more details.

Materials Fee:
Registration fee: $45

Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Birth date (Please note that children must be born before January 1, 2015 to be part of this program) *
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Grade Child is entering in the fall *
T-shirt size preference *
Allergies *
Please describe any medical or behavior considerations that would allow us to best serve your child. If there are no concerns, please state "none." *
Your answer
Please list first and last names all siblings also registering for this program. Please submit a separate form for each child. If you have already filled out a form for another sibling, you may skip the rest of this form and submit at the end since you've already entered the information.
Your answer
Would your child like to audition for a speaking role or singing solo? (For children age 7 and older). Please select the best time that works for you. Details about how auditions is on our main site. *
It's understandable for families to have vacations for part of the summer so long as you expect your children can participate for 8 out of the 10 program nights and rehearsals. Please list any known dates your child won't be able to attend. *
Kids Rock Program Nights: July 1, 8, 25, 1 August 8,1 5, 22 Extra rehearsals as needed: Sat. August 18 & Sat. Aug. 25 10am-12pm Performance Sunday, August 26th in the morning (time to be decided)
Your answer
I support my child's commitment to this program and will encourage attendance and help him/her learn the music and speaking parts for the musical portion of the program. *
Any special considerations we should know about? For example, if your child would not like to be part of the performance either with a speaking role and with singing, a request can be made to be part of a technical team.
Your answer
Do you give permission to Neelsville Church to use photos of your children for website, social media, or other promotional uses? *
By signing and dating this form, I release Neelsville Church from liability and hold the church and its representatives harmless for the duration of Vacation Bible School. Your typed name counts as your signature for this online form. *
First and last name and date
Your answer
You may skip down and submit the form if you'd already entered the rest of the information for another sibling in your family.
Street Address
If you'd already filled this out for another sibling, you may skip this step.
Your answer
City
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Your answer
State
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Your answer
Zipcode
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Your answer
Parent/Guardian 1 First and Last Name
Please provide the name of the parent who will primarily be dropping off and picking up your child. If you'd already filled this out for another sibling, you may skip this step.
Your answer
Parent/Guardian 1 Phone Number
If you'd already filled this out for another sibling, you may skip this step.
Your answer
Parent/Guardian 1 E-mail
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Your answer
Parent/Guardian 2 First and Last Name
If you'd already filled this out for another sibling, you may skip this step.
Your answer
Parent/Guardian 2 Phone Number
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Your answer
Parent/Guardian 2 E-mail
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Your answer
If either parent/guardian cannot be reached in case of emergency, what is the name of another responsible adult who could be contacted?
If you'd already filled this out for another sibling, you may skip this step.
Your answer
Phone number for alternative responsible adult listed above.
If you'd already filled this out for another sibling, you may skip this step.
Your answer
In addition to the emergency contact already listed, please list the name of all persons who have permission to pick up all of your children attending .
If you'd already filled this out for another sibling, you may skip this step.
Your answer
How did you hear about Kids Rock?
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Do you attend a church?
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If you do attend a church, what is the name of your church? Example: Neelsville
If you'd already filled this out for another sibling, you may skip this step.
Your answer
Are you available to serve as a volunteer for this program and would like to be sent a volunteer application? Background checks are conducted for all volunteers.
If you'd already filled this out for another sibling, you may skip this step.
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