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2010 VBS ONLINE REGISTRATION

July 19-23 ~ 9:00am-12noon

Deadline is July 4
Please complete a separate registration for each child

 

Grade Entering in Fall:
  Pre-K (must be age 4 by 6/1/10) through 6th grade

 

Child's LAST Name: 

Child's FIRST Name:

 

Address: (include city, state & zip

 

Parent/Guardian LAST Name:

Parent/Guardian FIRST Name:

 

EMAIL: 

 

Home Phone:  

Cell Phone: 

 

Home Church (if any):

Any Allergies/Dietary Restrictions: 

 

Anything else you'd like us to know about your child?      

 

EMERGENCY CONTACT

Name: 

Phone: 

MEDICAL RELEASE

I understand that I will be notified in the case of a medical emergency involving my child. However, in the event I cannot be reached, I authorize Hope Presbyterian Church to call a doctor and/or provide necessary medical services in the event my child is injured or becomes ill. I understand that Hope Presbyterian Church will not be responsible for medical expenses incurred, but that such expenses will be my responsibility as parent/guardian. I agree to notify the church in the event of any health changes that would restrict my child’s participation in any normal activities. I also understand that the adult supervisors reserve the right to restrict my child from any activity that they do not feel is within the physical capabilities of my child. I release Hope Presbyterian Church, its staff, and officers from any and all liability for injury resulting from my child’s participation in this activity. I, being the parent/legal guardian of the above named child, do consent to the participation of my child in the activities of Hope Presbyterian Church’s VBS.

PARENT/GUARDIAN NAME: 

PEDIATRICIAN'S NAME & PHONE NUMBER: 

Please Note:  You will be asked to SIGN this release form on the first day of VBS.  However, filling this information out in advance will greatly expedite the registration process.  Thank you!

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Please list the names of anyone who has your permission to pick up your child from VBS.          

After clicking on the "SUBMIT FORM" button, you will be redirected to the Home Page.  A confirmation email will be sent to you within 24hrs.  Thank you so much for your interest in our VBS program.  We look forward to meeting you! 

Please be sure to send an EXTRA T-shirt, labeled with your child's name, on the first day of VBS so that we may apply the VBS logo.