VBS Registration 2024

VBS Registration Form - One form per child. Please complete a separate form for each child you are registering.

Child Information

Name

Address

Birthdate

Grade (Select grade currently enrolled.)

Food Allergies/Medical Concerns/Special Needs (Please list and explain anything that will affect the child's time at VBS. For example, my child is allergic to dairy and cannot have any snacks with milk or eggs listed as an ingredient.)

Parent Name (Primary contact in case of emergency)

Phone (cell # that we can text)

This address will receive a confirmation email

Parent 2 Name

Phone

Special Requests

Any Special Requests (i.e. - pair my child with a friend they've invited)

Release Information

Release Authorization (Please list any adults other than Parent 1 & 2 who are authorized to pick up your child from VBS. Your child will not be released to anyone not listed on your form.)

Medical and Liability Release

By checking this box I give the group leaders at Fellowship of Champions the authorization to secure medical aid for my child should it be necessary during a church related event. I consent for my child (listed above) to be under the care of Fellowship of Champions. I hereby authorize and hospital, clinic, physician, doctor, nurse or technician to furnish my child, named above, any medical care treatment necessary as a result of injuries sustained or other emergency medical care treatment as the circumstances require while being transported from and back to the church and while at the place of destination. I hereby authorize representatives of Fellowship of Champions to retain or acquire said medical care and treatment on my behalf if I cannot be reached by telephone or there is not time or opportunity to make such a telephone call. I agree not to hold such a person responsible for any damages arising from the giving on such consent.

I agree

Media Release

By checking this box, I give permission for my child, named above, to be photographed and videotaped during church activities. My child's image may appear in print or online promoting the church's activities, including the church's website, promotional brochures, worship presentations, and social media. I understand that my child's name will not be used in any of these circumstances.

I agree I decline. My child's picture will not be taken and will not appear in the wrap up video shown at the end of VBS.

Shirts

T-Shirt Size (optional purchase for $10) YS (6-8) YM (10-12) YL (14-16) Adult S Adult M Adult L

Payment for Shirts (if you are registering after May 13, size is not guaranteed).

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

VBS Registration 2024

Description

Please Fix the Following