VACATION BIBLE SCHOOL 2024 CHILDCARE REGISTRATION
Childcare for children who are not yet in Kindergarten is ONLY available to parents serving in VBS or participating in the Charis New Moms' Fellowship. All childcare registration forms will be reviewed to confirm you are approved to serve or will be attending the Charis Fellowship.
How many children are you registering?
*
Please Select
1
2
3
4
Child's Information
First Child
First Child's Name
*
Child 1 First Name
Child 1 Last Name
First Child's Gender
Male
Female
First Child's Birth Date
*
Please select a month
January
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Year
First Child's Age
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CHILD 1: Does your child have allergies or a medical condition we should know about?
*
Yes
No
CHILD 1: Please indicate any allergies or medical information we may need to know about the child (including food allergies).
CHILD 1: Do you have any special requests for this child?
*
Yes
No
CHILD 1: Please indicate your special requests for your child.
Second Child
Second Child's Name
*
Child 2 First Name
Child 2 Last Name
Second Child's Gender
Male
Female
Second Child's Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
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Day
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Year
Second Child's Age
*
CHILD 2: Does your child have allergies or a medical condition we should know about?
*
Yes
No
CHILD 2: Please indicate any allergies or medical information we may need to know about the child (including food allergies).
CHILD 2: Do you have any special requests for this child?
*
Yes
No
CHILD 2: Please indicate your special requests for your child.
Third Child
Third Child's Name
*
Child 3 First Name
Child 3 Last Name
Third Child's Gender
Male
Female
Third Child's Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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31
Day
Please select a year
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2020
2019
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Year
Third Child's Age
*
CHILD 3: Does your child have allergies or a medical condition we should know about?
*
Yes
No
CHILD 3: Please indicate any allergies or medical information we may need to know about the child (including food allergies).
CHILD 3: Do you have any special requests for this child?
*
Yes
No
CHILD 3 Please indicate your special requests for your child.
Fourth Child
Fourth Child's Name
*
Child 4 First Name
Child 4 Last Name
Fourth Child's Gender
Male
Female
Fourth Child's Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
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10
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12
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14
15
16
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31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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2006
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1987
1986
1985
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1981
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1978
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1971
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Year
Fourth Child's Age
*
CHILD 4: Does your child have allergies or a medical condition we should know about?
*
Yes
No
CHILD 4: Please indicate any allergies or medical information we may need to know about the child (including food allergies).
CHILD 4: Do you have any special requests for this child?
*
Yes
No
CHILD 4: Please indicate your special requests for your child.
Parent/Legal Guardian Information
Parent/Legal Guardian Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Do you consider Calvary Chapel Chino Valley your home church?
*
Yes
No
If no, what is the name of your home church?
Will you be serving during VBS? (selecting "yes" does not sign you up to serve)
*
Yes
No
Have you already signed up to serve?
Yes
No
Are you participating in the Charis New Mom's Fellowship during VBS? (selecting "yes" does not sign you up for the devotion)
*
Yes
No
Emergency Contact
Emergency Contact (other than parent/guardian listed above)
*
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Child Release Information
We the undersigned, parents of said minor, do hereby authorize Calvary Chapel of the Chino Valley as agents for the undersigned to consent to an x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general supervision of any physician and surgeon licensed under the provisions of the Medicine Practice Act on the Medical Staff of any hospital or medical clinic whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of aforesaid agent to given specific consent to any and all such diagnosis, treatment of hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code 3 of California. (Allows parents or Guardian to authorize any adult to consent to medical or dental treatment as stated in paragraph No. 1 above). This authorization shall remain effective until July 31, 2024 unless sooner revoked in writing delivered to said agent.
*
I Agree
Parent/Legal Guardian Signature
Parent/Legal Guardian Signature
Today's Date
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Month
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Day
Year
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