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VBS Registration Form
Welcome to our online registration form!
10376 Felch Street, Zeeland, MI 49464 | Phone (616) 772-4907 | Fax (616) 772-5078
VBS Registration Form
June 18-21, 2012
6:15 - 8:30 pm
June 24, 2012
11am Morning Worship Service
Lunch Following Service
Community VBS is open to children 3 years of age and potty trained to those entering 4th grade.
1st Child's Name:
Age while attending VBS:
Birth Date:
School Grade Fall '12:
Health Concerns:
Name of special friend your child may want to be with (guaranteed until June 4):
Street Address:
City:
Zip:
Parent/Guardian's Name:
Home Phone:
Cell Phone:
Are you interested in volunteering?
Home Church:
Email Address:
Do you agree to the terms:
How did you hear about VBS:
Hospital preferred in case of emergency:
Name of family physician:
Physician Phone:
If parent cannot be reached in case of emergency, we MUST have two names and phone numbers we can reach:
1) Name:
2) Name:
Phone:
Phone:
In checking the "Yes, I Agree" on this form, I certify that the abouve information is correct and give permission for the use of photographs including my son/daughter to be used in church publicity. On behalf of my child participant, I assume all risk of personal injury, damage, and expense as the result of participation in the Community VBS. I authozie staff to obtain proper medical diagnosis, hospitalization, secure proper tratment for , and to order injections, anesthesia, or surgery of my child, and assume the responsibility of all medial bills, if any.
Prefer to not use our online registration, click here to download a printable registration form!
2nd Child's Name:
Age while attending VBS:
Birth Date:
School Grade Fall '12:
Name of special friend your child may want to be with (guaranteed until June 4):
3rd Child's Name:
Age while attending VBS:
Birth Date:
School Grade Fall '12:
Name of special friend your child may want to be with (guaranteed until June 4):
Health Concerns:
Health Concerns:
In the event that I, the parent/guardian, am unable to pick up my child, I authorize the following adults listed below to pick up him/her form Community Reformed VBS. I understand this must be an adult (no siblings my pick up my child) and ONLY the people listed will be allowed to pick up my child. Only prior written agreed-upon authorization will be accepted.
1) Name:
Relationship:
2) Name:
Relationship:
