Road Trip Registration Form

Vacation Bible School 2025 Sign up

Join us on this SUPER FUN Road Trip!
Traveler Information

Please fill out for each child
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade Just Finished *
They will be placed in a group based on their last finished grade.
MaleFemale
T-Shirt Size
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Cell Number *
Format: (000) 000-0000.
E-mail 1*
example@example.com
Name

First NameLast Name
Cell Number
Format: (000) 000-0000.
E-mail 2
example@example.com
Emergency Information
Emergency Contact's Name #1 *

First NameLast Name
Relationship #1*
Phone Number 1*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Emergency Contact's Name #2

First NameLast Name
Relationship #2
Phone Number 2
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Does the Traveler have ANY allergies, chronic illness, or medical conditions we need to know of? If yes, please describe here

Pick up Authorization

Please note, if they are not on this list, they will not be able to pick up the children!!
Pick up person 1*

First NameLast Name
Relationship*
Pick up person 2*

First NameLast Name
Relationship*
Can Not Pick up (if any)

First NameLast Name
Can Not Pick up (if any)

First NameLast Name
Media Release

I hereby consent to the participation in the taking of photographs, movies, or video recording of the child named on this form by Westminster Presbyterian Church.

I also grant the right to edit, use, and reuse said products for non-profit purposes including use in print, in slideshows, on the internet, and other forms of social media. I also hereby release Westminster Presbyterian Church and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.
Medical Release and Authorization

I, the undersigned parent or guardian of the child(ren) named on this form, do hereby authorize adult volunteers of Westminster Presbyterian Church as agents for the undersigned, to consent to any medical or surgical care deemed advisable by any accredited physician or surgeon in an approved emergency or hospital.

I further release from any liability Westminster Presbyterian Church, and any of its ministers or leaders in the event of an accident en route, during and returning from the above mentioned event. This agreement does not apply to claims for intentional misconduct or gross negligence.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature

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Date

MonthDayYear
Date
Payment
This year there will be a small fee to attend our fun filled week!

$25 per kids / $20 per sibling.

In order to make your payment, we ask that you go to

https://abundant.co/wpcsnellville/give

It will bring you to the churches online giving program. Please choose the "VBS" section in the drop down menu.

Please bring in a copy of payment confirmation on the first day of Registration.
Should be Empty:

Vacation Bible School 2025 Sign up

Traveler Information

Pick up Authorization

Payment