VBS online 2023 Registration Form

August 8-11
9:15 am to 12:15 pm

Open to children age 4 to going into grade 7.
(All children MUST be 4 before August 31, 2023 and potty trained to attend.)

Our Preschool program is for children age 4 to going into Kindergarten & the Elementary program is for children going into grade 1 to going into grade 7.

Registration is open until July 31 - Early Bird Rate ends July 12 - Cost is $35 per child or $100 for three or more children of the same household before July 12. $50 per child or $140 for three or more children of the same household from July 13 to July 31.

If you are registering children from a different household please fill out one form for each household.
How many children are you registering for VBS 2023?*
CHILD INFORMATION:
Child Name*

First NameLast Name
Gender*
Birthdate MM/DD/YYYY*
Grade as of Sept 2023*
Age (as of August 31, 2023)*
Please list all allergies or learning differences of child to help us create a positive environment for everyone. (Down's Syndrome, Tourettes, FASD, Epilepsy, Autism, etc.):
If child requires a full time aide at school please call us to see if you need to provide an aide for VBS.
Name of one child your child would like to be grouped with.
Every effort will be made to make this possible, however we cannot make any guarantees.
CHILD #2 INFORMATION:
Child Name

First NameLast Name
Gender
Birthdate MM/DD/YYYY
Grade as of Sept 2023
Age (as of August 31, 2023)
Name of one child your child would like to be grouped with.
Every effort will be made to make this possible, however we cannot make any guarantees.
CHILD #3 INFORMATION:
Child Name

First NameLast Name
Gender
Birthdate MM/DD/YYYY
Grade as of Sept 2023
Age (as of August 31, 2023)
Name of one child your child would like to be grouped with.
Every effort will be made to make this possible, however we cannot make any guarantees.
CHILD #4 INFORMATION:
Child Name

First NameLast Name
Gender
Birthdate MM/DD/YYYY
Grade as of Sept 2023
Age (as of August 31, 2023)
Name of one child your child would like to be grouped with.
Every effort will be made to make this possible, however we cannot make any guarantees.
CHILD #5 INFORMATION:
Child Name

First NameLast Name
Gender
Birthdate MM/DD/YYYY
Grade as of Sept 2023
Age (as of August 31, 2023)
Please list all allergies or learning differences of child to help us create a positive environment for everyone. (Down's Syndrome, Tourettes, FASD, Epilepsy, Autism, etc.):
If child requires a full time aide at school please call us to see if you need to provide an aide for VBS.
Name of one child your child would like to be grouped with.
Every effort will be made to make this possible, however we cannot make any guarantees.
PARENT/GUARDIAN INFORMATION:
Parent 1 / Guardian Name*

First NameLast Name
Does Parent 1 reside in the same home with the child(ren)?*
Parent 2 / Guardian Name

First NameLast Name
Does Parent 2 reside in the same home with the child(ren)?
Family E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 1 Phone Number*

Area CodePhone Number
Parent 2 Phone Number

Area CodePhone Number
I would be willing to volunteer as:
VBS and Safety and Risk Management Training will be on Wednesday, August 2 at 6:30 pm
Emergency Contact

First NameLast Name
Emergency Phone Number

Area CodePhone Number
Relationship to child
Your child will be cared for as if he/she was our child: it is understood that caution will be taken by the persons in charge to prevent injury but neither those in charge nor the church or church leadership will be held responsible in the case of an accident. I understand that SGAC, its staff or agents reserve the right to dismiss a participant who is in their opinion a hazard to the safety and well-being of themselves and of others or who appears to have rejected the reasonable guidelines of the activity.
I agree with the above statement*

Yes
Still photos and videos will be taken periodically during VBS but only used for purposes of promoting the ministries of the church onsite or online. I give permission for still photos and videos to be taken of my child.
I agree with the above statement*

YesNo
Please note a parent/guardian or their designate will be required to come to drop off and pick up their child every day.
Please select your form of payment
Payment

Registration will be completed once payment has been received. Please fill out one form per household.
Payment
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VBS Registration * DO NOT click this box if you are paying in office$35.00CAD

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CHILD INFORMATION:

CHILD #2 INFORMATION:

CHILD #3 INFORMATION:

CHILD #4 INFORMATION:

CHILD #5 INFORMATION:

PARENT/GUARDIAN INFORMATION:

Payment