VBS online 2022 Registration Form

August 8-12
9:15 am to 12:15 pm

Open to children age 4 to going into grade 7.
(All children MUST be 4 before August 31, 2022 and potty trained to attend.)

Cost: May 2 to July 13 - $35 per child or $100 for three or more children of the same household.

July 14 to August 1 - $50 per child or $140 for three or more children of the same household.

How many children are you registering? *

Child Name *

First Name Last Name

Gender *

Birthdate MM/DD/YYYY *

Grade as of Sept 2022 *

Age (as of August 31, 2022) *

Please list all allergies or learning differences of child that will help us create a positive environment for everyone. (Down's Syndrome, Tourettes, FASD, Epilepsy, Autism, etc.):

If child requires a full time aide at school please call the off to see if you need to provide an aide for VBS.

Name of one child your child would like to be grouped with.

Every effort will be made to make this possible, however we cannot make any guarantees.

Child Name

First Name Last Name

Gender

Birthdate MM/DD/YYYY

Grade as of Sept 2022

Age (as of August 31, 2022)

Please list all allergies or learning differences of child that will help us create a positive environment for everyone. (Down's Syndrome, Tourettes, FASD, Epilepsy, Autism, etc.):

If child requires a full time aide at school please call to see if you need to provide an aide for VBS.

Name of one child your child would like to be grouped with.

Every effort will be made to make this possible, however we cannot make any guarantees.

Child Name

First Name Last Name

Gender

Birthdate MM/DD/YYYY

Grade as of Sept 2022

Age (as of August 31, 2022)

Please list all allergies or learning differences of child that will help us create a positive environment for everyone. (Down's Syndrome, Tourettes, FASD, Epilepsy, Autism, etc.):

If child requires a full time aide at school please call us to see if you need to provide an aide for VBS.

Name of one child your child would like to be grouped with.

Every effort will be made to make this possible, however we cannot make any guarantees.

Child Name

First Name Last Name

Gender

Birthdate MM/DD/YYYY

Grade as of Sept 2022

Age (as of August 31, 2022)

Please list all allergies or learning differences of child that will help us create a positive environment for everyone. (Down's Syndrome, Tourettes, FASD, Epilepsy, Autism, etc.):

If child requires a full time aide at school please call us to see if you need to provide an aide for VBS.

Name of one child your child would like to be grouped with.

Every effort will be made to make this possible, however we cannot make any guarantees.

Child Name

First Name Last Name

Gender

Birthdate MM/DD/YYYY

Grade as of Sept 2022

Age (as of August 31, 2022)

Please list all allergies or learning differences of child that will help us create a positive environment for everyone. (Down's Syndrome, Tourettes, FASD, Epilepsy, Autism, etc.):

If child requires a full time aide at school please call us to see if you need to provide an aide for VBS.

Name of one child your child would like to be grouped with.

Every effort will be made to make this possible, however we cannot make any guarantees.

Parent 1 / Guardian Name *

First Name Last Name

Does Parent 1 reside in the same home with the child(ren)? *

Parent 2 / Guardian Name

First Name Last Name

Does Parent 2 reside in the same home with the child(ren)?

Family E-mail *

Address *

Street Address

Street Address Line 2

City

Postal / Zip Code

Parent 1 Phone Number *

Area Code Phone Number

Parent 2 Phone Number

Area Code Phone Number

I would be willing to volunteer as:

VBS and Safety and Risk Management Training will be on Wednesday, August 3 at 6:30 pm

Emergency Contact

First Name Last Name

Emergency Phone Number

Area Code Phone Number

Relationship to child

Your child will be cared for as if he/she was our child: it is understood that caution will be taken by the persons in charge to prevent injury but neither those in charge nor the church or church leadership will be held responsible in the case of an accident. I understand that SGAC, its staff or agents reserve the right to dismiss a participant who is in their opinion a hazard to the safety and well-being of themselves and of others or who appears to have rejected the reasonable guidelines of the activity.

I agree with the above statement *

Yes

Still photos and videos will be taken periodically during VBS but only used for purposes of promoting the ministries of the church onsite or online. I give permission for still photos and videos to be taken of my child.

I agree with the above statement *

Yes No

Please note a parent/guardian or their designate will be required to come to drop off and pick up their child every day.

Please select your payment method. *

Payment

VBS Registration $ 35.00 CAD

Quantity online Quantity Pay in Office

Total $ 0.00 CAD

CHILD INFORMATION:

CHILD #2 INFORMATION:

CHILD #3 INFORMATION:

CHILD #4 INFORMATION:

CHILD #5 INFORMATION:

PARENT/GUARDIAN INFORMATION:

Payment