CBC Vacation Bible School

Zoomerang

CBC Vacation Bible School 2022
Please fill out the information below.

Registration fee is $5 per child with a maximum charge of $15 per family

The registration fee includes crafts and snacks. If interested in a scholarship or have questions contact Randy Owens (843) 525-0089.

We also have a limited number of T-shirts. Please indicate if you wish to purchase any. They are $7 each ($8 for XXL and XXXL).

At the end of the form you will be asked to affirm that you are the parent or guardian of the children being registered.
Parent/Guardian Information
Parent or Guardian *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code
Cell Phone *
Please enter a valid phone number.
Email Address *
example@example.com
Emergency Contact Name & Approved Pick-up *

First Name Last Name
Emergency Contact Phone *
Please enter a valid phone number.

VBS Registration Number of kids being registered. ($15 max per family)

$ 5.00 Quantity

Adult T-Shirt

$ 7.00

Size	Quantity
S
M
L
XL

Item subtotal: $ 0.00

Big Adult T-Shirt

$ 8.00

	Quantity
XXL
XXXL

Item subtotal: $ 0.00

Youth T-Shirt

$ 7.00

Size	Quantity
XS
S
M
L
XL

Item subtotal: $ 0.00

Enter coupon

Total

$ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Child Information
Child 1 Name *

First Name Last Name
Child 1 Birthday *

Month Day Year
Date
Child 1 Grade *
What grade was child in during 2021-22 school year
Child 1 Gender *

Male Female
Child 1 Buddy Request (optional)
Please pair this child with the above-named child. The requested buddy's registration form should reflect your child's name. All buddy requests must be made no later than Tue. June 14 to assure placement.
Child 1 Allergies
Child 2 Name

First Name Last Name
Child 2 Birthday

Month Day Year
Date
Child 2 Grade
What grade was child in during 2021-22 school year
Child 2 Gender

Male Female
Child 2 Buddy Request (optional)
Please pair this child with the above-named child. The requested buddy's registration form should reflect your child's name. All buddy requests must be made no later than Tue. June 14 to assure placement.
Child 2 Allergies
Child 3 Name

First Name Last Name
Child 3 Birthday

Month Day Year
Date
Child 3 Grade
What grade was child in during 2021-22 school year
Child 3 Gender

Male Female
Child 3 Buddy Request (optional)
Please pair this child with the above-named child. The requested buddy's registration form should reflect your child's name. All buddy requests must be made no later than Tue. June 14 to assure placement.
Child 3 Allergies
Child 4 Name

First Name Last Name
Child 4 Birthday

Month Day Year
Date
Child 4 Grade
What grade was child in during 2021-22 school year
Child 4 Gender

Male Female
Child 4 Buddy Request (optional)
Please pair this child with the above-named child. The requested buddy's registration form should reflect your child's name. All buddy requests must be made no later than Tue. June 14 to assure placement.
Child 4 Allergies
Child 5 Name

First Name Last Name
Child 5 Birthday

Month Day Year
Date
Child 5 Grade
What grade was child in during 2021-22 school year
Child 5 Gender

Male Female
Child 5 Buddy Request (optional)
Please pair this child with the above-named child. The requested buddy's registration form should reflect your child's name. All buddy requests must be made no later than Tue. June 14 to assure placement.
Child 5 Allergies
Child 6 Name

First Name Last Name
Child 6 Birthday

Month Day Year
Date
Child 6 Grade
What grade was child in during 2021-22 school year
Child 6 Gender

Male Female
Child 6 Buddy Request (optional)
Please pair this child with the above-named child. The requested buddy's registration form should reflect your child's name. All buddy requests must be made no later than Tue. June 14 to assure placement.
Child 6 Allergies
By checking this box I affirm that I am the parent or legal guardian of the child(ren) listed above. I give my consent for their participation in Community Bible Church's Vacation Bible School program and waive any liability against the church and any other parties. *

I Consent and Affirm
Should be Empty:

Zoomerang

Parent/Guardian Information

Child Information