Adventure Week VBS Registration
Please complete the form below to register your child for Adventure Week VBS at the Community Church in Rivers, MB for the week of July 15-18, 2024 from 9:00am - 12:00pm
Child's Information
Child's Name
*
First Name
Last Name
Sex
*
Male
Female
Birthday
*
-
Month
-
Day
Year
Date
Grade
*
Please Select
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Information
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Cell Phone #
*
Please enter a valid phone number.
Parent/Guardian Email
*
example@example.com
Parent/Guardian Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Parent/Guardian Email
example@example.com
Drop-Off & Pick-up (if different than Parent/Guardian)
First Name
Last Name
Emergency Contact
In Case Of Emergency, Please Contact:
*
First Name
Last Name
Emergency Contact Number (if different than Parent/Guardian)
Please enter a valid phone number.
Relationship to Child
*
Medical Information
Personal Health ID Number (9 Digit)
*
Provincial Registration Number (6 Digit)
*
Does your child have any allergies?
*
No
Yes
If yes, please explain.
Does your child have any physical, emotional, mental, behavioural concerns or limitations that their leader(s) should be aware of?
*
No
Yes
If yes, please explain.
Does your child take any regular medication that they will need to take during Adventure Week?
*
No
Yes
If yes, please provide details.
Permissions
I give permission for photographs and videos be taken of my child for promotional purposes by a VBS staff member.
*
Yes - photos may be used for in-house and online promotion
Yes - photos may only be used only for in-house promotion
No - photos may not be used for in-house or online promotion
I give my permission for my child to attend Calvary Temple's VBS event 'Set Sail' on Monday July 15 - Thursday July 18.
I am herby released from any liability. In the event that my child requires special medication, x-rays or treatment, the parent/ guardian will be notified immediately. In case of surgical emergency, I hereby give permission to the physician selected by Calvary Temple staff to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child as named above.
Printed Name
First Name
Last Name
Submit
Should be Empty: