St. Peter's United Church of Christ Vacation Bible School Registration Form
LIVE IT OUT LOUD Love • Serve • Forgive • Trust • Show Jesus through actions
VBS will run June 22-25, 2026 from 5:00-7:30 pm. It is open to participants of ALL AGES!
The Cost of VBS this year is $10 per participant. We have financial scholarships available to anyone in need. Please fill out the form below for each person who will be attending. Thank you
Name
*
First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Email
*
example@example.com
I am registering as a
Participant
Youth Volunteer
Adult Volunteer
Tee Shirt Size
*
Children's Small
Children's Medium
Children's Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Adult XXXL
The cost is $10 per person attending, to help cover the costs. Would you like a financial scholarship to help cover this cost?
*
Yes
No
$10 cost can be paid with check or cash in an envelope dropped off at church labeled "Vacation Bible School" with the participant name, or paid online. When paying online check "Give to Christian Education" and then enter the participants name under "Comments" on the secone page. https://stpetersucc.breezechms.com/give/online
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Grade entering in fall
*
Please Select
PreK
K
1
2
3
4
5
6
7
8
Adult
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
*
First Name
Last Name
Relationship
Phone Number
*
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
If the above person cannot be reached, please list an additional Emergency Contact
First Name
Last Name
Relationship
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Any there any Allergies or Medical Conditions/ Medications that the staff should be aware of?
*
Yes
No
Please give details, and list anything else you'd like the staff to be aware of:
I, undersigned, agree with the following statements:
*
In the event of an injury or illness, I give permission to the leaders to secure necessary medical treatment, and I relieve them of any and all liability in such event, understanding that I will be contacted promptly if such a situation arises. I understand that the church may record the image, voice, or likeness of the applicants. I hereby give permission for St. Peter’s United Church of Christ to use images in conjunction with publicizing events without remuneration to me or my child(ren). Personal information is not released in any publicity materials without the expressed consent of the parent. This form remains in effect from June 22-25, 2026 or until revoked by the parent or guardian. It is the parent’s responsibility to inform St. Peter’s United Church of Christ of any changes or additions.
I, as parent/guardian of the child listed above, give my permission for him/her to accompany pastors, advisors, and/or recognized chaperones of St. Peter’s United Church of Christ on Church sponsored outings and activities. I understand there are dangers and risk of injury inherent in participating in these outings and activities, but still desire to allow the above named to participate in such activity. Therefore, the undersigned, for and in consideration of the opportunity to allow the participant to participate in outings and activities, and for other good and valuable consideration, does hereby forever release, quit and forever discharge St. Peter’s United Church of Christ, it pastors, advisors, employees, insurers, agents, servants, and recognized chaperones (hereafter referred to as “Released Parties”) from any and all claims, demands, rights and causes of action of any kind or arising out of any and all known and unknown, foreseen or unforeseen bodily and personal injuries, property damage or the consequence thereof, resulting from any accident, casualty or event involving the above named participant and arising out of participating in Church sponsored outings and activities. I UNDERSTAND THIS MEANS I AGREE NOT TO SUE ANY AND ALL OF THE RELEASED PARTIES FOR ANY INJURIES ORPROPERTY DAMAGE RESULTING TO THE ABOVE NAMED PARTICIPANT DURING OR IN CONNECTION WITH HIS OTHER PARTICIPATION IN CHURCH SPONSORED OUTINGS AND ACTIVITIES. I understand this Release does not waive liability for intentional reckless acts, as such claims cannot be waived, but do understand this Release waives claims of any other kind, specifically including claims for negligence, against the Released Parties. FURTHER AND BY WAY OF INDEMNITY, the undersigned hereby expressly understands and agrees to indemnify and hold harmless the Released Parties, their employees, agents, or insures, against any and all claims for damages, costs or expenses, incurred by the Released Parties, their employees, agents or insures, as a result of any accident or injury which might occur while the above named participant is participating in Church sponsored outings and activities and which may result from the negligence of the Release Parties, their employees, and agents, third parties or any combination there of. The undersigned further declares and represents that no promise, inducement or agreement not contained in this written agreement has been made to the undersigned and that this Release contains the entire agreement between the parties and the terms of the Release contractual and not mere recital. The undersigned further acknowledges the opportunity to negotiate this Release with an authorized member of St. Peter’s United Church of Christ.
I am interested in helping:
I am interested in helping with Christian Education
I am interested in serving on our Church's Christian Education Ministry Team
I am interested in serving as a Youth Volunteer
I am not able to help at this time
Please type your full name here, indicating that you agree to all of the above document
*
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Last Name
Date
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