Vacation Bible School Registration Form June 16-20, 2025 ~ 9:00am-12:00pm

Vacation Bible School Registration Form June 16-20, 2025 ~ 9:00am-12:00pm

Ages 4 through 5th grade ~ Deadline to register is May 19th
STUDENT INFORMATION
Name*

First NameLast Name
Birth Date *

MonthDayYear
Date
Gender*
Grade completed*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Please enter a valid phone number.
Secondary Phone Number*
Please enter a valid phone number.
Email*
example@example.com
EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.
Primary Parent/Guardian*

First NameLast Name
Relationship to child*
Phone Number*
Email
example@example.com
Alternate Parent/Guardian #1*

First NameLast Name
Relationship to child*
Phone Number*
Email
example@example.com
Alternate Guardian #2

First NameLast Name
Relationship to child
Phone Number
Medical Information
Please list all allergies - or type "none" if there are none*
Does your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)*

YesNo
Please list all medical concerns - or type "none" if there are none*
Additional Information
VBS photos/videos are taken for promotional purposes related to New Hope Presbyterian Church and Vacation Bible School. These pictures appear in various media outlets such as The News & Opportunities and our Facebook page and webpage. Do you allow your child to be included in these photos/videos?*

YesNo
Shirt Size:*
Registration Fee is $25 per child due by May 19, 2025.

Please make checks payable to New Hope Presbyterian Church and indicate VBS registration on memo line or click here to pay online

*Registration fee includes snacks and a t-shirt for each child.
By submitting this form, I acknowledge I have read and understand the above information.
Signature*

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Vacation Bible School Registration Form June 16-20, 2025 ~ 9:00am-12:00pm

Medical Information

Additional Information