YeeHaw! MyChurch 2019 VBS Registration
Dates: June 3th-6th, 2019, 6:30 - 8 pm each night
Location: Sahuarita Lake Park, 15466 S. Rancho Sahuarita Blvd, Sahuarita, AZ 85629
Contact: website@mychurchaz.com
Email address *
Student Name (First) *
Your answer
Student Name (Last) *
Your answer
Date of Birth *
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DD
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YYYY
Gender *
Grade Entering in Fall 2019 *
(NOTE: If child is 3 years old, a parent or guardian must stay with the child)
Home Church
Your answer
Primary Parent/Guardian *
This is the first person we will contact in case of emergency
Primary Parent/Guardian Name *
Your answer
Primary Guardian Contact Phone Number During VBS *
Your answer
Address *
Your answer
Secondary Emergency Contact *
This is the second person we will contact if the primary contact is not able to be reached.
Secondary Emergency Contact Name *
Your answer
Secondary Emergency Contact Phone Number *
Your answer
Do you have a friend you would like to be placed with? If so, who?
Your answer
Allergies/Special Needs/Additional Notes
Your answer
PARENTAL RELEASE AND WAIVER AGREEMENT *
By completing and submitting this form: I consent for my child to participate in the activities of MyChurch and voluntarily and absolutely release MyChurch from all liability for personal injury and/or damage as a result of engaging in any activities of MyChurch. I authorize and give full consent to MyChurch to use on their website all photographs in which I/my child appear while involved in ministries of MyChurch.
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