VBS 2024 Registration
Please fill out this form and click submit.
Date of Registration
*
Child's Name
*
Advancing to Grade
*
Birthday
*
Age
*
Child Brought By:
*
Home Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Home Phone
*
Parents Email
This address will receive a confirmation email
Relationship to Student
*
Food Allergies?
*
Please select all that apply.
Yes
No
List Any Allergies or Medical Concerns
Physical Limitations
*
Please select one option.
Don't Allow Stressful Activities such as Running, etc.
Limit to light activity
No Limitations
Emergency Contact Name
*
Emergency Contact Phone
*
Doctor's Phone
*
List any Siblings Attending VBS Here
Church Affiliation:
Church Membership At:
List Persons Who May Pick Up Child:
*
Will Guardian Remain on Site During VBS?
*
Please select all that apply.
Yes
No
I give my permission to Shearer Presbyterian Church to photograph and video record my child and use in promotional materials and or video.
*
Please select all that apply.
Yes
No
Parent's or Guardian's Signature
*
Submit
Description
Please fill out this form and click submit.
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