CBC Vacation Bible School 2023

Keepers of the Kingdom

CBC Vacation Bible School 2023
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 NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone *
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Emergency Contact Name & Approved Pick-up*

First NameLast Name
Emergency Contact Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Second Emergency Contact Name & Approved Pick-up (if desired)

First NameLast Name
Second Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.

VBS Registration

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

$5.00 Quantity

Adult T-Shirt

$7.00

Size	Quantity
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
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 NameLast Name
Child 1 Birthday*

MonthDayYear
Date
Child 1 Age on September 1, 2023*
MaleFemale
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 Wed. June 14 to assure placement.
Child 1 Allergies
Child 2 Name

First NameLast Name
Child 2 Birthday

MonthDayYear
Date
Child 2 Age on September 1, 2023
MaleFemale
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 Wed. June 14 to assure placement.
Child 2 Allergies
Child 3 Name

First NameLast Name
Child 3 Birthday

MonthDayYear
Date
Child 3 Birthday on September 1, 2023
MaleFemale
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 Wed. June 14 to assure placement.
Child 3 Allergies
Child 4 Name

First NameLast Name
Child 4 Birthday

MonthDayYear
Date
Child 4 Age on September 1, 2023
MaleFemale
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 Wed. June 14 to assure placement.
Child 4 Allergies
Child 5 Name

First NameLast Name
Child 5 Birthday

MonthDayYear
Date
Child 5 Age on September 1, 2023
MaleFemale
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 Wed. June 14 to assure placement.
Child 5 Allergies
Child 6 Name

First NameLast Name
Child 6 Birthday

MonthDayYear
Date
Child 6 Age on September 1
MaleFemale
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 Wed. June 14 to assure placement.
Child 6 Allergies
I Consent and Affirm
Should be Empty:

Keepers of the Kingdom

Parent/Guardian Information

Child Information