Rice Community VBS - Child Registration 2024

Parent's Information

Name

This address will receive a confirmation email

Phone

Address

Additional Phone Number for Emergency Contact

Do you have a home church?

Yes No

Home Church Name

How many children will be attending

Child #1

First Name

Last Name

Sex

Age

Bithdate

Grade Level Just Completed

Does your child have allergies?

Does your child have any special needs?

Child #2

First Name

Last Name

Sex

Age

Birthdate

Grade Level Just Completed

Does your child have any allergies?

Does your child have any special needs?

Child #3

First Name

Last Name

Sex

Age

Birthdate

Grade Level Just Completed

Does your child have any allergies?

Does your child have any special needs?

Child #4

First Name

Last Name

Sex

Age

Birthdate

Grade Level Just Completed

Does your child have any allergies?

Does your child have any special needs?

Child #5

First Name

Last Name

Sex

Age

Birthdate

Grade Level Just Completed

Does your child have any allergies?

Does your child have any special needs?

Medical and Media Release

Medical Release

By checking this box, I give my permission for the VBS staff to administer basic first aid to my child if injured. I understand the VBS staff will contact emergency services in the event of a significant injury and all expenses will be paid by me

Media Release By checking this box, I give Shepherd of the Pines permission to use photographs/videos taken at VBS of my child.

Permission

By checking this box, I give permission for my child (named above) to attend the Vacation Bible School listed above. I understand that the information I give for this registration will only be used by the VBS hosting church.

Electronic Signature*

*By entering my name in the box above, I am providing my electronic signature on this form.

Want to volunteer? Click here to get started!

Description

June 2 - June 6, 2024. 6:30-8:30pm

Update we are maxed out for 4 year olds.

This is a FREE VBS for children age 5 through 5th grade. It's Sunday, June 2nd through Thursday, June 6, 2024 from 6:30pm - 8:30pm. Max will be 130 kids and will be first come first serve basis. Volunteers are vital for VBS to happen, click the link below if you are available to help.

Rice Community VBS - Child Registration 2024

Description

Please Fix the Following