Dacula UMC VBS 2023
Online Registration will close when we are at capacity or on 6/1/23 at midnight. NO WALK UP REGISTRATION IS ALLOWED. Who's ready to go on a CAVE QUEST!?! VBS 2023 will be looking into how to FOLLOW JESUS, THE LIGHT OF THE WORLD. Join us for Dacula UMC's annual VBS on June 12th-15th. Each morning we begin at 9am and wrap up the day at 12pm. To attend, children must be rising Kindergarten through rising fifth grade as of Fall 2023. You can register up to 3 kids per registration form.
Cost:
Cost is $10 per child, with a $25 family max (when registering 3 or more children.) Payment for VBS can be made online by visiting the giving page on www.daculaumc.org. You may also drop-off or mail the payment to Dacula UMC 2655 Fence Road, Dacula GA 30019. Please put 'VBS 2023' on the "for" line of your check. Make checks payable to Dacula UMC. *Payment should be made by BEFORE VBS begins.
#1 Child Information:
#1 Child's First Name:
*
#1 Child's Last Name:
*
#1 Child's Date of Birth (Child must be 5 years old to attend):
*
-
Month
-
Day
Year
Date Picker Icon
#1 Child's Gender:
*
Male
Female
#1 Child's Grade in Fall 2023:
*
Please Select
Rising Kindergarten
Rising 1st
Rising 2nd
Rising 3rd
Rising 4th
Rising 5th
#1 Child's T-Shirt Size:
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
#2 Child Information:
#2 Child's First Name:
#2 Child's Last Name:
#2 Child's Date of Birth (Child must be 5 years old to attend):
-
Month
-
Day
Year
Date Picker Icon
#2 Child's Gender:
Male
Female
#2 Child's Grade in Fall 2023:
Rising Kindergarten
Rising 1st
Rising 2nd
Rising 3rd
Rising 4th
Rising 5th
#2 Child's T-Shirt Size:
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
#3 Child Information:
#3 Child's First Name:
#3 Child's Last Name:
#3 Child's Date of Birth (Child must be 5 years old to attend):
-
Month
-
Day
Year
Date Picker Icon
#3 Child's Gender:
Male
Female
#3 Child's Grade in Fall 2023:
Rising Kindergarten
Rising 1st
Rising 2nd
Rising 3rd
Rising 4th
Rising 5th
#3 Child's T-Shirt Size:
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Parent Contact Info:
Mother's First and Last Name OR Guardian's First and Last Name:
*
Father's First and Last Name:
Preferred Email Address:
*
Email address will be added to the VBS 2023 mail chimp mailing list in order to send VBS updates, information and announcements. You may unsubscribe at any time.
Best Contact Phone Number:
*
Alternate Phone Number:
Child Lives With:
Please Select
Mom
Dad
Both
Grandparent
Guardian
Best Way to Reach You:
Please Select
Email
Phone
Please enter your full address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Emergency Contact Information:
Emergency Contact Name - other than parents:
*
Emergency Contact Phone Number:
*
Food Allergies, Medicine Allergies, or Other Medical/Behavior Concerns. If none enter N/A:
Additional Information: Please include any custody permissions. Include special requests (carpool pairings, request friends to be placed together). All requests will be noted and we will try to accommodate.
How did you find out about Dacula UMC VBS 2023?
Almost done.... :)
Liability Release:
We, the undersigned parents or legal guardians of child and/or children listed on VBS 2023 online registration, a minor(s), do hereby release, forever discharge, and agree to hold harmless Dacula United Methodist Church, its directors, officers, employees, adult volunteers, youth volunteers and agents from responsibility and liability for any personal injury, sickness, or death, as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned and the child participant(s) that occurs while said child is participating during any activity, trip or event connected with Dacula United Methodist Church. Furthermore, we, as parents or legal guardians, hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in any activity, trip, retreat or event connected with Dacula United Methodist Church. Further, authorization and permission is hereby given to said Dacula United Methodist Church to furnish any necessary transportation, food, and lodging for this participant. The undersigned further hereby agrees to hold harmless and indemnify Dacula United Methodist Church, its directors, officers, employees, adult volunteers, youth volunteers, and agents for any liability sustained by said youth organizations as the result of the negligent, willful, or intentional acts of said participant, including expenses incurred attendant thereto. In the event of an emergency, I hereby authorize an adult leader of these youth organizations or my child’s church, as an agent for me, to consent to any x-ray examination, emergency transportation, medical, dental, surgical diagnosis, treatment or hospital care advised and supervised by a physician, surgeon, or dentist, (as appropriate) licensed to practice under the laws of the state where the services are rendered, either at a doctor’s office or in any hospital. We further assume responsibility for the decisions so made and agree to be fully financially responsible for any and all medical, hospital, and/or emergency treatment so secured for our child. We understand that, given proper time and circumstances, we will be notified by phone as soon as possible when treatment is needed or secured. Furthermore, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we hereby assume all transportation costs involved.
By typing my name in the box below, I electronically sign and affirm that I have read, understand and agree to the above statement:
*
Today's Date
*
-
Month
-
Day
Year
Date Picker Icon
Media Release:
We hereby consent to the use of videotapes, photographs, slides, audio recordings, or any other visual or audio reproduction in which my child and/or children may appear from this children/youth event. I understand that these materials may be used for promotion of Dacula United Methodist Church. I release Dacula United Methodist Church, its directors, officers, employees, adult volunteers, youth volunteers, and agents from any liability connected with the use of my child’s picture or voice recording as part of their print, video and online promotion materials.
By typing my name in the box below, I electronically sign and affirm that I have read, understand and agree to the above statement:
*
Today's Date
*
-
Month
-
Day
Year
Date Picker Icon
Save
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform