Kingsway Hayes Community Church — VBS 2014 Registration Form

Welcome to Weird Animals VBS!
Get Ready for a One-of-a-Kind Adventure!
JULY 28 – AUGUST 1
VBS 2014 Registration

VBS is available for children 4 years old to just completed 6th grade.
Registration Deadline: JULY 11th // Cost: $15 per child
How many children are you registering?*
Child Information
First Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Last School Grade Completed*
Child's Age*
T-Shirt Size

Small (6-8)Medium (10-12)Large (14-16)
Medical or other information we may need to know about the child (including food allergies).*
Second Child
Child's Birth Date*

MonthDayYear
Child's Name*

First NameLast Name
Child's Age*
Last School Grade Completed*
T-Shirt Size

Small (6-8)Medium (10-12)Large (14-16)
Medical or other information we may need to know about the child (including food allergies).*
Third Child
Child's Birth Date*

MonthDayYear
Child's Name*

First NameLast Name
Last School Grade Completed*
Child's Age*
T-Shirt Size

Small (6-8)Medium (10-12)Large (14-16)
Medical or other information we may need to know about the child (including food allergies).*
Fourth Child
Child's Name*

First NameLast Name
Child's Age*
Child's Birth Date*

MonthDayYear
Last School Grade Completed*
T-Shirt Size

Small (6-8)Medium (10-12)Large (14-16)
Medical or other information we may need to know about the child (including food allergies).*
Child Release Information
Parent/Legal Guardian Name*

First NameLast Name
Home Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Church
Approved Persons to whom the child (children) may be released to each night after VBS (Please provide at least two)*

First NameLast Name
Approved Person #2*

First NameLast Name
Approved Person #3

First NameLast Name
Approved Person #4

First NameLast Name
Are there any persons to which the child (children) may NOT be released to?*

YesNo
Who may your child (children) NOT be released to?
Emergency Contact 1 (other than parent/guardian listed above)*

First NameLast Name
Relationship to Child*
Emergency Contact 1 Phone Number*

Area CodePhone Number
Emergency Contact 2 (other than parent/guardian listed above)*

First NameLast Name
Relationship to Child*
Emergency Contact 2 Phone Number*

Area CodePhone Number
Media Release
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child appears in to be used by the church in printed and/or electronic media, including the church's website.

I Agree
Should be Empty:

VBS 2014 Registration

Child Information

First Child

Second Child

Third Child

Fourth Child

Child Release Information

Media Release