TICC Vacation Bible School Registration

Vacation Bible School - Rooted in Love

Hosted by Triumphant in Christ Church
Dates: July 6th-July 10th

Time: 9:00am-1:00pm

Ages: 6-12

Address: 121 E. Adams Ave, Harlingen, TX, 78550

Lunch will be provided!

For more information or questions, feel free to message 956-245-9858.
Child's Information

Note: A registration form is to be filled out for EACH child.
Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Child's Age
Gender
Address
City
State
Zip
Parent or Legal Guardian Information
Parent/Legal Guardian
Relation to Child
Work Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Parent/Guardian Email
example@example.com
Parent /Legal Guardian 2
Relation to Child
Work Phone 2

Area CodePhone Number
Cell Phone 2

Area CodePhone Number
Parent/Guardian 2 Email
example@example.com
Emergency Contact Information

Please include information of someone we can reach if parent or guardian is not available.
Emergency Contact #1 Name (if parent or guardian is not available)
Relation to Child
Emergency Contact #1 Number

Area CodePhone Number
Emergency Contact #2 Name(if parent or guardian is not avaliable)
Relation to Child
Emergency Number #2

Area CodePhone Number
Church Information
Church you attend
Church you are coming with (if any)
How did you hear about Vacation Bible School with Triumphant in Christ Church?
Health Information
It is our policy to contact the parent or guardian as soon as possible in the event of a medical emergency. If the information has changed on the day of registration, please speak to registration team during child drop off.

Please bring all medication in ORGIANAL CONTAINER or you will not be allowed to leave the medication with our volunteers. No exceptions. All prescriptions must be in that child's name.

All fields are required below. If nothing applies, please put "NONE" in the box. Thank you!
Any physical, mental or other condition that would require special attention or medication?
List any allergies (ex: bees,peanuts, dairy)
Any dietary needs that we should know about?
List all medications (prescribed) that you would like our volunteers to be aware of - example: inhaler
Other information you would like to communicate
Child Release
Child Release: List anyone, including parents, to whom your child can be released)
NOTE: We will be asking for a picture ID during pick up.
Disclaimer & Agreement
By hitting submit and putting your initials:
Parent/Guardian Confirmation
Child Release Authorization Policy
Arrival and Dismissal Agreement
Consent to Participate in Program Activities
Behavior Policy
Photo/Video Release
Electronic signature, please insert full name
This will serve as the parent/guardian’s signature.
Date

MonthDayYear
Date
Should be Empty:

Vacation Bible School - Rooted in Love

Child's Information

Parent or Legal Guardian Information

Emergency Contact Information

Church Information

Health Information

Child Release

Disclaimer & Agreement