General Information
Vacation Bible School Registration Form
Student Name
*
First Name
Last Name
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Class Level
*
Pre-K
Primary
Intermediate
Secondary
Adult
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Residence Information
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Emergency Contact Information
Primary Emergency | Contact Name
*
First Name
Last Name
Primary Emergency | Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Primary Emergency | What is your relationship with this person?
*
Secondary Emergency | Contact Name
First Name
Last Name
Secondary Emergency | Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Emergency | What is your relationship with this person?
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Medical Information
Please list any of the following: medication allergies, food allergies, or any other important health concerns. If none, please type N/A.
*
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Transportation, Media Consent & Activity Permission
I give permission for my child (or myself) to participate in all scheduled VBS activities, including but not limited to, indoor and outdoor games, crafts, lessons, and supervised recreation. I understand that reasonable precautions will be taken to ensure the safety and well-being of all participants.
*
Yes
No
My child will need transportation to and from the VBS.
*
Yes
No
N/A
I give permission for my child (or myself) to be photographed or recorded during VBS activities for strictly church-related purposes (presentations, newsletters, or social media).
*
Yes
No
By signing below, I release the Tri-County Alliance of Churches and Ministers, leaders, staff, and volunteers from any and all liability for any accident that may occur during VBS activities.
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian/Adult Student Name
*
Submit
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