Vacation Bible School 2025 TRUE NORTH

Vacation Bible School

"True North: Trusting Jesus in a Wild World"

July 28 - Aug 1

9AM - 1PM
Avondale Presbyterian Church

2821 Park Rd

Charlotte, NC 28209

Cost: $75 per child (members); $100 per child (non-members)

Ages: Rising Kindergarten through Rising 6th grade

Lunch: Children need to bring a packed lunch and water bottle, snacks will be provided.

Registration: Registration is complete when forms and payment are received.
Spaces are limited, first come, first serve. Registration closes July 2, 2025.

Volunteers needed!

Please email Amanda Shanks amandajshanks@gmail.com to volunteer.
REGISTRATION FORM

Register Each Child Separately
Child's First Name*
Child's Last Name*
Child's nickname/goes by
Age*
today
Rising Grade*
Rising School*
Child's Home Address*
full address
Best Phone # for Family*

Parents / Guardians

Contact Information
First & Last Name #1*
Parent/Guardian #1
Email address #1*
example@example.com
Mobile Phone #1*
Parent/Guardian #1
Other Phone #1
Parent/Guardian #1
First & Last Name #2
Parent/Guardian #2
Email address #2
example@example.com
Mobile Phone #2
Parent/Guardian #2
Other Phone #2
Parent/Guardian #2
Please share any information that might be helpful for our volunteers to ensure that your child has a positive experience.*
if you can't think of anything, type NA
Food: This camp serves food. Please be sure to list food allergies on the Medical form.

Cancellation: If you need to cancel your child’s registration, please notify the church office as soon as possible. (Call: 704-333-6194)

Next pages: Emergency Medical Form and Photo Release Form

PERMISSION FOR MEDICAL TREATMENT:

This is to certify that as the parent / guardian of: ____(field below-Full Name of Child)_____/____(field below-Date of Birth)_______ who is ____(field below)___ years of age, that if an emergency should arise while my child is participating in an Avondale Vacation Bible Camp, and I am unable to be notified, I give my permission to the medical staff selected by the Vacation Bible Camp Director(s) or Avondale staff to administer any medications or treatments, including anesthesia or surgery, that are deemed necessary.

Signature / Date ___(fields below)____
Full Name of Child*
Full legal name for medical purposes
Child's Date of Birth*

MonthDayYear
Date
who is _____ years old*
age
Parent / Guardian Signature*

Clear
Date you sign Emergency Medical Form*

MonthDayYear
today
Contacts for the Emergency Medical Form

(Emergency contacts may be different than Parent/Guardian contacts on the Registration Form)
Emergency Contact #1 Name*
Parent/ Guardian
Emergency Contact #1 Mobile*
phone
Emergency Contact #1 Work/Other
phone
Emergency Contact #1 Email
email
Emergency Contact #2 Name*
Emergency Contact #2 Mobile*
phone
Emergency Contact #2 Work/Other
phone
Emergency Contact #2 Email
example@example.com
Additional Contact Person in case of emergency
First & Last Name
Additional Contact Person - Relationship
relationship
Additional Contact Person - Mobile
phone
Additional Contact Person - Work/Other
phone
MEDICAL INFORMATION: (you may also upload a copy of insurance card)

Insurance Company to be billed for charges resulting from emergency medical treatment:
File Upload

Cancelof
Company Name*
insurance
Address*
insurance provider address
City*
State*
Zip*
Insurance Phone Number*
ID Number*
Group Number*
Family Physician - Name*
Phone Number*
Family Physician
Hospital Preference*
Location/ Address*
Hospital Preference
Does your child have allergies to food or drugs, any physical restrictions, etc. that we should be aware of?*
Type NA if none
Has your child received a tetanus shot in the past two years?*
Waiver Agreement

I, the undersigned parent/guardian of the registrant for the use of and participation in/on church facilities or property, Avondale Presbyterian Church, Charlotte, N.C. do hereby release and discharge Avondale Presbyterian Church, and its authorized volunteers and staff from liability for any injuries occurring out of my child’s use of the facility. Furthermore, in case of an accident or medical emergency, if the staff or volunteers are unable to contact the parent(s)/guardian(s) for participants, 17 and under, I hereby grant permission to said staff to administer necessary first aid and/or take registrant to the nearest hospital or medical facility for additional treatment. I understand that I as the parent or guardian am responsible for ambulatory, hospital and medical fees that are associated as a result of receiving the appropriate and necessary medical care. I, the undersigned parent/guardian of the registrant for the use of and participation in/on church facilities or property, Avondale Presbyterian Church, Charlotte, N.C. understand and am aware that the recreational activities conducted in and through the church facilities/property involve a risk of injury. I voluntarily allow my child to participate in these activities with the knowledge of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury. I, the undersigned parent/guardian of the registrant for the use of and participation in/on church facilities or property, Avondale Presbyterian Church, Charlotte, N.C., understand that I am responsible for any damage or breakage to Church property caused by my child as identified by the instructor, staff or church representative.
Parent/Guardian Signature Waiver Agreement*

Clear
Date*

MonthDayYear
Date

Photo Release Form
I hereby grant permission to Avondale Presbyterian Church to use photographs and/or video of me/my child taken at Avondale Presbyterian Church in publications, news releases, online, and in other communications related to the mission of Avondale Presbyterian Church. If you change your mind, please contact the Church Office.
Pictures for VBS*

Yes, I allow pictures to be used. (Complete names below)No, sorry, not at this time.
Your Children's Names*
Photo Release form
Parents/Guardians*
Photo Release form
Signature for Photo Release*

Clear
Date*

MonthDayYear
Date

After clicking submit you will be redirected to a payment page where you can securely enter a credit card and complete payment. If you prefer to pay by check, payment must be received by the church office no later than Monday, July 7th, 2025.

If you would like to volunteer to help with VBS, please contact Amanda Shanks at amandajshanks@gmail.com or 804-338-9847.

For more information about Avondale ministries, visit our website: www.avondalepresbychurch.org

Contact/ Questions: Fay Palmer, Administrative Coordinator
fay@avondalepresbychurch.org
704-333-6194

Avondale Presbyterian Church
2821 Park Rd, Charlotte, NC 28209
www.avondalepresbychurch.org

Should be Empty:

Vacation Bible School

REGISTRATION FORM

Parents / Guardians

Contacts for the Emergency Medical Form

Waiver Agreement

Photo Release Form