Heading
Child’s Name
*
First Name
Last Name
Age
*
Gender
*
Please Select
Male
Female
Does the child have any allergies? If yes, please list them below:
*
Does the participant have any medical condition that we should be aware of? If yes, please explain below:
*
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Additional Children
This page is for a parent/guardian who is registering multiple children. Please ensure for every additional child you register, each box is accurately filled. However, if you are registering only 1 child, you can skip this page.
2nd Child’s Name
First Name
Last Name
2nd Child’s Age
2nd Child’s Gender
Please Select
Male
Female
Does the child have any allergies? If yes, please list them below:
Does the participant have any medical condition that we should be aware of? If yes, please explain below:
3rd Child’s Name
First Name
Last Name
3rd Child’s Age
3rd Child’s Gender
Please Select
Male
Female
Does the child have any allergies? If yes, please list them below:
Does the participant have any medical condition that we should be aware of? If yes, please explain below:
4th Child’s Name
First Name
Last Name
4th Child’s Age
4th Child’s Gender
Please Select
Male
Female
Does the child have any allergies? If yes, please list them below:
Does the participant have any medical condition that we should be aware of? If yes, please explain below:
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Parent / Guardian Information
Name
*
First Name
Last Name
Relationship to Child
*
Telephone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
How many children are you registering?
*
Please Select
1
2
3
4
Are you registering your kids for the physical or virtual class?
*
Physical
Virtual
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Terms and Conditions
I allow my child to participate in the Discipleship Academy’s VBS for the 1st-3rd of August,2024.
I hereby authorize the church, bible study conductor, volunteer personnel to conduct first aid, and medical care in the event of an emergency situation. I agree to pay for all the medical care expenses and costs in a given situation that medical care is needed.
I release the organizers from any liabilities that might happen during the activity and hold them harmless in the event of damages, injuries, or accidents.
I confirm that all information in this form is accurate and true to the best of my knowledge.
I agree that by typing my name and clicking submit, I am electronically signing this registration form and agreeing to the terms and conditions clearly stated above.
*
Do you allow the organizers to take photos or videos during the activities of your child for advertising and marketing purposes that will be posted on social media?
*
Yes
No
Date Signed
*
-
Month
-
Day
Year
Date
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Payment of Registration Fee
The registration fee is N5,000 per child. You can make payment to 1014134479, Leading Lights Children Bible Club, Zenith Bank.
After payment has been made, upload your proof of payment
*
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