VBS Registration United Methodist Church Los Banos (Campers should be Entering K-6th grade)
Event Dates and Times : July 1-5, 9 am-12 noon
Event Address: 1031 Iowa Ave. Los Banos, CA
Contact: 209-826-4181 or
Age July 1st:
Grade in the Fall:
Primary Emergency Contact. Include Name, Phone and Relationship to child:
Secondary Emergency Contact Include Name, Phone and Relationship to child:
*****In case of emergency, I understand that the VBS leaders will make every effort to contact the parents, guardians or emergency contact persons named above, prior to any treatment. I also giver permission for the leaders of VBS to take necessary action for the health of my child in the event that the parents, guardians or emergency contact persons cannot be reached. VBS assumes no financial responsibility. ******
Yes. By checking "YES" I am signing this form electronically and agree to the above statement.
Insurance Company and Policy Number:
Please list any health concerns or allergies of the child attending:
Are there any custody issues that we should be aware of? Please explain if yes.
How did you hear about VBS?
What church do you regularly attend?
We will be taking group and individual photos. We plan to distribute them to the children involved in VBS and will use some to promote our program on our website and Facebook. Mark: "Yes" if you allow this action. "No" if you do not.
T-SHIRT INFORMATION for Camper:
I would be willing to help with decorations before.
I would be willing to help during the week.
I would be willing to help clean up.
I will not be able to help at this time.
I understand there is no cost to me for VBS but I am willing to donate (_) toward this VBS program so it can continue to service the youth of our community.:
I can not give at this time.
$35 (Actual cost per camper to put the event together)
Any other amount.
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