LifeHouse VBS Registration
Register for IN THE WILD VBS June 24-28, 6:30-8:00 pm at Providence Creek Academy. For ages 4 years old to 5th Grade.
Parent/Guardian Name: *
Your answer
Phone Number: *
Your answer
Address: *
Your answer
Email: *
Your answer
Medical Information
Medical or other information we need to know. Please include any food allergies and name of child next to it. If your child has severe food allergies we ask that you bring their snack each day. Also, for safety reason we request children DO NOT wear FLIP FLOPS!
Medical Information *
Your answer
Emergency Contact (Other than listed above) & Approved to Pick-Up Child *
Your answer
Phone Number *
Your answer
Does your child attend Sunday School or Church *
May we have permission to photograph your child? *
May we have permission to use your child's photograph for the purpose of promotion? *
Children's Information
Please fill out the information below for each child.
Child's Name (1) *
Your answer
Birth Date (1) *
MM
/
DD
/
YYYY
Age or Grade you Just Finished (1) *
Gender (1) *
T-Shirt Size (1) *
Second Child
Please fill out the information below for your second child.
Child's Name (2)
Your answer
Birthdate (2)
MM
/
DD
/
YYYY
Age or Grade you Just Finished (2)
Gender (2)
T-Shirt Size (2)
Third Child
Please fill out the information below for your third child.
Child's Name (3)
Your answer
Birthdate (3)
MM
/
DD
/
YYYY
Age or Grade you Just Finished (3)
Gender (3)
T-Shirt Size (3)
Fourth Child
Please fill out the information below for your fourth child.
Child's Name (4)
Your answer
Birthdate (4)
MM
/
DD
/
YYYY
Age or Grade you Just Finished (4)
Gender (4)
T-Shirt Size (4)
Fifth Child
Please fill out the information below for your fifth child.
Child's Name (5)
Your answer
Birthdate (5)
MM
/
DD
/
YYYY
Age or Grade you Just Finished (5)
Gender (5)
T-Shirt Size (5)
Submit
Never submit passwords through Google Forms.
This form was created inside of Lifehouse. Report Abuse - Terms of Service