Valley Church VBS 2022

Christmas in July VBS will be July 18th- July 21st from 6:00-8:00pm.

Child Information

Child's Name *

First Name Last Name

Fall 2022 Grade (preK-5th Grade) *

Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe. *

Parent/Guardian Information

Name *

First Name Last Name

Cell Number *

Area Code Phone Number

E-mail *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Valley Church. In exchange for the acceptance of said child’s candidacy by Valley Church, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Valley Church.

Confirmation BY ACKNOWLEDGING AND SUBMITING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

VALLEY CHURCH VBS 2022