VBS-Registration Form

Registration Form

VBS

July 7th-11th

Pre-Registration NOW OPEN!

*Registration Extended to July 7, 2024

STUDENT INFORMATION

Name*

First NameLast Name

Gender*

Birth Date *

Last Grade Completed*

Age*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Primary Phone Number*

Please enter a valid phone number.

Have you previously attended VBS?

YesNo

If yes, what year?

Home Church (if any)

EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.

Primary Guardian/Caregiver*

First NameLast Name

Relationship to child*

Phone Number*

Medical Information

Please list all allergies -- or type "none" if there are none*

Does your child carry an epi-pen? (please note: if yes, it is the responsibility of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)*

YesNo

Please list all medical concerns -- or type "none" if there are none*

Additional Information

Please list the names of any other children (friends or family) that you would like placed in the same class as this child

VBS photos/videos are taken for promotional purposes related to Owensboro Cumberland Presbyterian Church and Vacation Bible School. These pictures appear in various media outlets such as The News and our Facebook page and webpage. Do you allow your child to be included in these photos/videos?*

YesNo

By submitting this form, I ackowledge I have read and understand the above information.