VBS Participant Registration Form
Register participants from preschool to rising 7th grade for the 'Full Throttle' VBS. As we head full speed into living a life for Jesus!
Participant's Full Name
*
First Name
Last Name
Participant's Date of Birth
*
-
Month
-
Day
Year
Date
Grade Entering in Fall
*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name 1
*
First Name
Last Name
Emergency Contact Phone Number 1
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name 2
*
First Name
Last Name
Emergency Contact Phone Number 2
*
Please enter a valid phone number.
Format: (000) 000-0000.
Allergies or Medical Conditions
*
Authorized Pick-Up Persons (other than parent/guardian)
*
Photo/Media Release Consent
*
Yes, I consent to my child's photo being used for VBS media.
No, I do not consent.
I give permission for my child to participate in Vacation Bible School activities at Lydia Mill Church of God. In the event of an accident or medical emergency, I authorize Lydia Mill Church of God VBS staff and volunteers to obtain emergency medical treatment for my child if I cannot be reached right away. I understand every effort will be made to contact me first. I accept responsibility for any medical expenses that may occur. By agreeing below, I confirm that the medical information provided for my child is accurate.
*
Yes, I acknowledge the above statement and consent for VBS staff to obtain medical treatment when necessary.
By submitting this form, I confirm that all information provided is accurate and complete to the best of my knowledge. I understand that this registration includes participation permissions, medical information, emergency contact information, and all policies related to Vacation Bible School at Lydia Mill Church of God. I acknowledge that I have read and understood all sections of this form prior to submission.
Register
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