VBS 2023

Hero Hotline VBS

Thank you for registering for Coker's 2023 Vacation Bible School for children finishing kinder - finishing 5th grade. June 26-29 | 9am - 12:00pm
Parent Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Second Parent Name (optional)

First NameLast Name
Second Parent Email
example@example.com
Second Parent Phone Number
Please enter a valid phone number.
Church Affiliation
Emergency Contact Other Than Parents

First NameLast Name
Emergency Phone Number
Please enter a valid phone number.
How many completed K-3rd grade children are your registering?
Child 1  First Name   Last Name Age/grade completed:      Age/grade completedDOB:    Date   Gender:   Male/Female
Allergies & Medical Needs Please list
Child 2 First Name   Last Name Age/Grade completed: Age/Grade Completed
DOB:Date Gender:   Male/Femail
Allergies & Medical Needs Please list
Child 3 First Name   Last Name  Age/Grade completed: Age/Grade completed
DOB:DateGender Male/Female
Allergies & Medical Needs Please list
Child 4 First Name   Last Name Age: Age/Grade Completed
DOB: DateGender Male/Female
Allergies & Medical Needs   Please list
How many completed 4th-5th graders are your registering?
Child 1   First Name   Last Name   Age/grade completed:   Age/Grade completed DOB:   DateGender   Male/Female
Allergies & Medical Needs   Please list
Child 2   First Name   Last Name Age/Grade completed:    Age/Grade completedDOB:   DateGender   Male/Female
Allergies & Medical Needs   Please list
Child 3   First Name   Last Name   Age/Grade completed:   Age/Grade Completed DOB:   DateGender   Male/Female
Allergies & Medical Needs   Please list
Child 4   First Name   Last Name   Age/Grade completed:   Age/Grade completed DOB:   DateGender  Male/Female
Allergies & Medical Needs   Please list
Health Release

In the event of an emergency and in my absence, I hearby give consent to any of the Coker UMC staff to seek medical attention for children(s) mentioned above. While understanding that all resonable safety precautions will be observed, I understand the possibilties of unforeseen hazards and the inherent possibilty at risk. I voluntarily agree not to hold harmless Coker United Methodist Church and its servants, volunteers, agents, and employees from all liabilty for personal injury for all actions taken in good faith during church activities.
Health Release

AgreeDisagree
Video/Photography Release

I understand Coker UMC from time to time produces material about its programs. I understand that my child named on this form may be included in videos or photographs taken by church or church activities. I herby give my consent to photograph and or video to be taken of my child to be used for church publicity on website, Facebook, or other social media.
Video/Photography Release

AgreeDisagree
Youth T-shirts are Optional
X-Small   How many      Small   How many
Medium   How manyLarge   How many
Adult T-shirts are Optional
Small   How many     Medium   How many
Large   How many   X-Large   How many
XX-Large   How many   XXX-Large   How many
Ways to Volunteer

Family LeaderAssistant Family LeaderSnack HelperCraft HelperGames HelperScience HelperDecorations HelperDrop off line helperPick Up Line HelperTear Down on Thursday

VBS 2023 Payment*

VBS - How many children are your registering?All total children

$15.00 Quantity

VBS - Total purchase t-shirtsDeadline to order T-shirts June 4.

$10.00 Quantity
Item subtotal:$0.00

VBS - CDMusic CD

$5.00 Quantity
Item subtotal:$0.00

Total

$0.00

Credit Card

Should be Empty:

Hero Hotline VBS

Credit Card