Clone of Wild Ones VBS 2025

LIFE CHURCH Vacation Bible School
Open to Kids 4 - 12 (Kindergarten - 5th grade)

Please complete a separate registration for each child attending

Camp is: July 20th-24th • 9:00am - 12:30pm daily
Participant's Name:

First NameLast Name
Do you regularly attend a church? If so, which church?

Other
Birth Date

MonthDayYear
Grade Level (entering for the 26-27 school year)
K - 5th ONLY
Medical concerns, food allergies or physical limitations (please clearly list any food allergies, medical concerns and medications your child is on)
Parent/ Guardian 1 Name:

First NameLast Name
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/ Guardian 2 Name: (Optional)

First NameLast Name
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Emergency Contact

First NameLast Name
Emergency contact relationship to child:
Emergency Phone
Format: (000) 000-0000.
Liability Release Form
MEDICAL RELEASE
I acknowledge & agree to the permission to treat form and the liability release form.
Should be Empty:

LIFE CHURCH Vacation Bible School