Vacation Bible School Registration 2023 – Second Presbyterian Church

Child's Name *

First

Last

Birthdate *

Child's gender *

Male
Female

Child's Grade (current 2022-2023 school year) *

Please list any allergies or other medical concerns that VBS staff should be aware of.

Child's T-shirt Size *

S
M
L

Do you want to register another child? *

Yes
No

Second Child's Name

First

Last

Second Child's Birthdate

Second Child's Gender

Male
Female

Second Child's Grade (current 2021-2022 school year)

Please list any allergies or other medical concerns that VBS staff should be aware of.

Second Child's T-shirt Size

S
M
L

Do you want to register a third child?

Yes
No

Third Child's Name

First

Last

Third Child's Birthdate

Third Child's Gender

Male
Female

Third Child's Grade (current 2021-2022 school year)

Please list any allergies or other medical concerns that VBS staff should be aware of.

Third Child's T-shirt Size

S
M
L

Parent Contact Information

Name *

First

Last

Parent Email *

Best phone number to reach you. *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

I'm affiliated with:

My family intends to make a registration payment by:

Paying Online (Link Provided Below)
Mailing a check (Address Provided Below)
Bringing a check to the first day of VBS

Parent Release Form *

I agree to the terms of the Parent Release Form

I, the parent/guardian of the above registered minor/minors, hereby authorize the director/s or adult leaders or caregivers of The Churches of Charles VBS to act on my behalf while I am absent, and consent to any x-ray examination, medical, dental or surgical diagnoses, medical treatment and hospital care advised and administered by emergency personnel or health care providers. A representative of The Churches of Charles will attempt to contact me in case of emergency. I hereby release The Churches of Charles, their staff, teachers, agents and advisors, from responsibility and liability for any injury or illness my child may sustain or from any claims, causes of action or demands that may arise in connection with my child’s/children’s participation in Vacation Bible School for any reason; including, but not limited to, claims of negligence of third parties in connection with, related to or as a result of any of these activities. This authorization shall remain in effect until revoked in writing and delivered to authorized agents of The Churches of Charles. I also give The Churches of Charles permission to use, reprint and produce any photographs or videos taken of my child/children during his/her/their participation in church activities. I understand that these images will remain anonymous and be used for ministry purposes only.

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