Vacation Bible School Student Registration Form
Roar: Life is Wild, God is Good
July 15-19, 2019 from 6:00 p.m. to 8:15 p.m.
Student's Full Name *
Your answer
Student's Birthday *
Month / Day / Year
Your answer
Age *
Your answer
School Grade Completed *
If in preschool, will your child attend Kindergarten next year?
Parent/Guardian Name *
Your answer
Address *
Number and Street, City, State, and Zip Code
Your answer
Parent's Cell Phone or Work Phone *
Your answer
Emergency Contact Name *
In the event of an emergency, we will contact the parent specified on this form. Please list an alternate Emergency Contact in case we are unable to contact you.
Your answer
Type of Emergency Contact *
Emergency Contact Phone Number *
Your answer
Please list any allergies, dietary needs, or other needs.
Your answer
Name of Home Church *
If "Other Church" please list
Your answer
Your Child's T-Shirt Size *
Each registered VBS student will receive a free t-shirt.
Would you like to purchase an adult t-shirt for $8 each?
If yes, please state in the box below the size you would like: adult small, medium, large, extra large, or 2XL AND the quantity of each size.
Your answer
Photography Release *
Do you grant permission for your child to be photographed and/or recorded? These images or recordings may be published on our church website or Facebook page.
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This form was created inside of New Bethlehem Presbyterian Church.