Vacation Bible School Childcare Registration
Childcare is for kids who are not yet in Kindergarten and is ONLY available to parents serving in VBS or participating in the Charis Moms' Fellowship. All childcare registration forms will be reviewed to confirm you are approved to serve or will be attending the Charis Moms' Fellowship.
How many children are you registering?
*
Please Select
1
2
3
4
Child's Information
First Child
First Child's Name
*
First Child's First Name
First Child's Last Name
First Child's Gender
*
Male
Female
First Child's Birthdate
*
-
Month
-
Day
Year
First Child's Age
*
First Child: Does your child have allergies or a medical condition we should know about?
*
Yes
No
First Child: Please indicate any allergies or medical information we may need to know about the child (including food allergies).
*
First Child: Please indicate any special requests you have for your child, including if you would like to request a friend for them to be in the same group. While we will do our best to accommodate requests, we cannot guarantee all placements.
*
Second Child
Second Child's Name
*
Second Child's First Name
Second Child's Last Name
Second Child's Gender
*
Male
Female
Second Child's Birthdate
*
-
Month
-
Day
Year
Second Child's Age
*
Second Child: Does your child have allergies or a medical condition we should know about?
*
Yes
No
Second Child: Please indicate any allergies or medical information we may need to know about the child (including food allergies).
*
Second Child: Please indicate any special requests you have for your child, including if you would like to request a friend for them to be in the same group. While we will do our best to accommodate requests, we cannot guarantee all placements.
*
Third Child
Third Child's Name
*
Third Child's First Name
Third Child's Last Name
Third Child's Gender
*
Male
Female
Third Child's Birthdate
*
-
Month
-
Day
Year
Third Child's Age
*
Third Child: Does your child have allergies or a medical condition we should know about?
*
Yes
No
Third Child: Please indicate any allergies or medical information we may need to know about the child (including food allergies).
*
Third Child: Please indicate any special requests you have for your child, including if you would like to request a friend for them to be in the same group. While we will do our best to accommodate requests, we cannot guarantee all placements.
*
Fourth Child
Fourth Child's Name
*
Fourth Child's First Name
Fourth Child's Last Name
Fourth Child's Gender
*
Male
Female
Fourth Child's Birthdate
*
-
Month
-
Day
Year
Fourth Child's Age
*
Fourth Child: Does your child have allergies or a medical condition we should know about?
*
Yes
No
Fourth Child: Please indicate any allergies or medical information we may need to know about the child (including food allergies).
*
Fourth Child: Please indicate any special requests you have for your child, including if you would like to request a friend for them to be in the same group. While we will do our best to accommodate requests, we cannot guarantee all placements.
*
Parent/Legal Guardian Information
Parent/Legal Guardian Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Do you consider Calvary Chapel Chino Valley your home church?
*
Yes
No
What is the name of your home church?
*
Will you be serving during VBS? (selecting "yes" does not sign you up to serve. Please sign up separately.)
*
Yes
No
Have you already signed up to serve?
*
Yes
No
Are you participating in the Charis New Mom's Fellowship during VBS? (selecting "yes" does not sign you up for the devotion. Please sign up separately.)
*
Yes
No
Emergency Contact
Emergency Contact (other than parent/guardian listed above)
*
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Phone Number
*
Format: (000) 000-0000.
Media Release
By registering for this event, I grant permission to the event organizers, staff, and representatives to photograph, video record, and otherwise capture my likeness, image, voice, and participation during event activities. I understand that these photographs, videos, and recordings may be used by the organization for promotional, educational, ministry, and advertising purposes, including but not limited to print materials, websites, social media platforms, presentations, and future event promotions. I understand that such use may occur now and in the future without further notice or compensation.
*
I release and hold harmless the organization, its employees, volunteers, and representatives from any claims arising out of the use of these photographs, videos, or recordings as described above.
Child Release Information
We the undersigned, parents of said minor, do hereby authorize Calvary Chapel of the Chino Valley as agents for the undersigned to consent to an x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general supervision of any physician and surgeon licensed under the provisions of the Medicine Practice Act on the Medical Staff of any hospital or medical clinic whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of aforesaid agent to given specific consent to any and all such diagnosis, treatment of hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code 3 of California. (Allows parents or Guardian to authorize any adult to consent to medical or dental treatment as stated in paragraph No. 1 above). This authorization shall remain effective until July 31, 2026 unless sooner revoked in writing delivered to said agent.
*
I Agree
Parent/Legal Guardian Signature
*
Parent/Legal Guardian Signature
Submit
Should be Empty: