VBS CHILD REGISTRATION
Please fill out this form and click submit.
Child Name
*
Birthdate
*
Preferred Pronouns
*
Home Church
*
Please select one option.
NONE
COLLEGE HILL UMC
GRACE PRESBYTERIAN CHURCH
ST. JAMES EPISCOPAL CHURCH
Plymouth Congregational Church
Select Option
NONE
COLLEGE HILL UMC
GRACE PRESBYTERIAN CHURCH
ST. JAMES EPISCOPAL CHURCH
Plymouth Congregational Church
School
*
Grade 2023-2024 School Year
*
Please select all that apply.
3 & 4 PreK and Potty Trained
Kindergarten
1st
2nd
3rd
4th
5th & 6th Mission Possible
Allergies or other Medical Conditions
Address
*
--
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
Adult 1 - Emergency Contact
*
Phone
*
Email
*
This address will receive a confirmation email
Adult 2 - Emergency Contact
*
Phone
*
Email
*
This address will receive a confirmation email
Shirt Size
*
Please select one option.
child xs
child s
child m
child lg
child xlg
adult sm
adult m
Option
Additional Persons Authorized to Pick Child(ren) Up
*
Please select one option.
None
Name/Cell
Name/Cell
Select Option
None
Name/Cell
Name/Cell
PHOTOGRAPHY/SOCIAL MEDIA I hereby grant permission for my child to be included, unnamed, in pictures connected with the Compassion Camp VBS program. I grant permission for my child to be included in student pictures featured on College Hill UMC, St. James Episcopal Church, Grace Presbyterian, Plymouth Congregational Church web pages and/or Social Media pages. In no case shall a student’s name, home address or telephone number appear in conjunction with any website or social media publication. I relinquish rights to the finished photos.
*
Please select all that apply.
yes
no
LIABILITY I hereby grant permission for my child to use all play equipment and participate in all the activities with the VBS program at College Hill UMC. College Hill UMC, the staff, and the VBS volunteers are not liable for any accidental injury, or illness, for any persons, on and off, College Hill UMC property.
*
Please select all that apply.
yes
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