Register for UPWARD BOUND VBS!!
Held June 2nd-6th 2025, 1:00-4:00pm 550 N National Road Columbus, IN 47201
Children's Information
Children's Information
*
Please list Allergies
Please describe any Medical Concerns
Parent/Guardian Information
Name
*
First Name
Last Name
Phone number
*
Email
*
example@example.com
Address
Address
Street Address Line 2
City
State
Zip
Would you like to add an additional emergency contact?
Yes
No
Emergency contact
Relationship to child
Phone
Who besides you may pick up your child?
*
Please list all persons who may pick up your child
Is there anything else we need to know to help your child(ren) have a great time learning about Jesus?
PERMISSION TO USE IMAGES AND VIDEO
COLUMBUS REFORMED PRESBYTERIAN CHURCH may record sounds, image, and video of your child while they are attending the VBS program.
*
CRPC may use sounds, images or videos of my child(ren) in church publications
Please do not use sound, and blur any images of my child(ren) in church publications
CRPC may NOT use sounds, images or videos of my child(ren) in church publications
PARENTGUARDIAN SIGNATURE
*
DATE
*
/
Month
/
Day
Year
Date
Submit
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