Vacation Bible School Student Registration

Child's Name*

First Last

Birth Date*

Grade Last Completed*

Does this child have any allergies or special needs?*

Yes
No

Please list allergies or special needs

T-Shirt Size

Would you like to register another child for VBS?

Yes
No

Child's Name

First Last

Birth Date

Grade Last Completed

Does this child have any allergies or special needs?

Yes
No

Please list allergies or special needs

T-Shirt Size

Would you like to register another child for VBS?

Yes
No

Child's Name

First Last

Birth Date

Grade Last Completed

Does this child have any allergies or special needs?

Yes
No

Please list allergies or special needs

T-Shirt Size

Would you like to register another child for VBS?

Yes
No

Child's Name

First Last

Birth Date

Grade Last Completed

Does this child have any allergies or special needs?

Yes
No

Please list allergies or special needs

T-Shirt Size

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent Name*

First Last

Parent Phone*

Parent Name

First Last

Parent Phone

VBS Newsletter Opt In*

Each day during VBS we will send an update of what happened that day. We will only send VBS related information. Would you like to receive these newsletters?

Yes
No

This field is hidden when viewing the form

Community Group Opt In*

We are looking at creating a group (like Facebook) where videos can be posted and we can share about the week. We will have prizes for teams who interact in this group.

Yes
No

Parent Email Address*

Emergency Contact*

Please list name, phone numbers and relationship of contact.

Will someone other than the parent be bringing or picking up your child(ren)?*

Yes
No
Staying at daycare

Pick-Up Contact

Please list name and phone number for the person who will be picking your child(ren) up from VBS if it will not be the parent listed on this form.

Photo/Video Release*

There will be photos taken during the VBS week, whether at in person or shared by the parents. These may be used for posting on our PCFC website, for our Facebook page, for our newsletter or for sharing within the church. Please mark whether you give permission for PCFC to share your child’s photos.

I give consent for PCFC to use my child’s photos
I DO NOT give consent for PCFC to use my child’s photos

Are you planning to attend the closing program?*

We will be having our closing program at noon Friday, July 18. After the program we will have a lunch.

Yes
No

How many people will be in your group for the closing program?

We want to make sure we have enough items for all who are attending the lunch. Please let us know how many people (including your children) will be coming to the closing program.

Church you attend:

How Did You Hear About Us?*

Attended before
Parma Kids Preschool
Referred by a friend
Website
Other

If other, please list how

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VBS Student Registration

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