VBS 2022

Summer 2022 VBS Program: July 25 - 29, 2022 9:00 AM to 12:00 PM

Thank you for your interest in our Summer 2022 VBS program. Please complete one registration application for each child attending. Cost per child will include all VBS activities, arts, crafts, snacks etc. Each child will receive one T-Shirt, a reusable Estes Rocket to assemble during STEAM time, and a pocket-size New Testament or complete Bible, all of which they can take home with them. It is our intention to have another rocket launch and BBQ on Friday, July 29th immediately following our noon closing at our fields located at 16 Hawkins Road, Centereach.

(The suggested donation is $50.00 per child for the week. If you cannot afford to make that donation, please contact Jim McCarrick at 631-836-4279)

Amount Paid

Child Information:

Child's Last Name *

Child's First Name *

Nickname

Gender

Male Female

Grade Just Finished

PK4 Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

One T-Shirt is included with your registration fee. Please use the drop down to indicate size.

T-Shirt Size

Parent Information:

Parent First Name *

Parent Last Name *

Parent Street Address *

Parent Street Address 2

Parent City *

Parent State *

Parent Zip Code *

Parent Email *

Parent Daytime Phone *

Parent Cellphone *

Emergency Contact Information

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone 1 *

Emergency Contact Phone 2 *

Alternate Pickup First Name

Alternate Pickup Last Name

Alternate Pickup Phone

Additional Information

Home Church

Does the child have any health, medical, food allergies, etc. that we should know about? *

Are there any orders of protection in effect regarding the child? *

To whom may the child be released to?: *

Medical Information

Allergies:

Medical Issues or Special Needs:

Medical Release:

I give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

Media Release:

I hereby grant my permission for the VBS staff to copyright and use photographs / videos taken at VBS of the minor designated above in any manor or form for any purpose lawful at the time. I waive my right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.

Permission to Attend:

I give my permission for my child (named above) to attend the VBS program listed above. I understand that the information I give for this registration will only be used by the VBS hosting church and school.

*

Permission Granted to All Three Above

Our Savior New American School Terms and Conditions:

Children are expected to dress in modest school attire. We ask that children do not bring cell phones to VBS as they become a distraction to the child as well as the staff. In case of an emergency, please call the school at 631-588-2757 and we will get you in touch with your child. Please do not send your child if they are not feeling well.

By selecting the "I agree to the terms and conditions" checkbox, you are signing this Agreement electronically and consent to be bound by its terms and conditions.

*

I agree to the terms and conditions.

*

Signature

Suggested Donation is $50.00 *

VBS 2022

$ 50.00

Total

$ 0.00

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.