Vacation Bible School Registration
PREK-GRADE 3 (JULY 26-29) | JR YOUTH (GRADES 4-6) - (JULY 31)
CHILD INFORMATION - PART 1
This information must be provided for each child attending VBS.
Child's First and Last Name
GRADE GOING INTO FALL OF 2021
PRE-SCHOOL (must be 3 and potty-trained)
GRADE 4 (JR YOUTH)
GRADE 5 (JR YOUTH)
GRADE 6 (JR YOUTH)
Does your child have any MEDICAL CONCERNS or ALLERGIES that we need to be aware? There will be a nurse and emergency personnel on site during VBS.
Does your child have any special social, emotional, or learning concerns? What can you tell us to help us serve your child in the best possible way.
FAMILY INFORMATION - PART 2
If you have multiple children registering for VBS, you only need to complete this section one time. GO RIGHT ON TO PAGE 3.
Please list the first and last names of children represented by the following family information.
Parent or Guardian Name 1
Phone Number - PARENT OR GUARDIAN 1
Parent or Guardian Name 2
Phone Number - PARENT OR GUARDIAN 2
Street Address Line 2
State / Province
Postal / Zip Code
Name of Home Church if you have one.
All are welcome here!
Designated Pick Up Person #1
Designated Pick Up Person #2
Designated Pick Up Person #3
SIGNATURE PAGE - PART 3
As per our Safe Church Plan, please note that all volunteers are screened and trained in safety protocols to ensure a safe and secure place of worship.
Pictures and videos will be taken throughout the week by Port Community Church VBS for use in our Craft Projects, Activities, Church social media, VBS Program. I hereby give my permission for my child to be included in the pictures.
Medical Release: I (We), the parent(s) or guardian(s) of the above listed child(ren) grant permission for our child(ren) to participate in Vacation Bible School at Port Community Church and to receive medical treatment if necessary. If I (we) or the listed child care provider or emergency contact cannot be reached, I (we) give our permission to the staff to secure the services of a licensed physician to provide necessary care, including anesthesia, for my child's well-being.
I (we) also release and agree to hold harmless Port Community Church and all its participants from any liability and assume all risk of injury, damage or expenses as the result of participation in activities in Vacation Bible School.
Type Above Name and Date (00/00/00)
BE SURE TO HIT 'SUBMIT'.
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