(VBS) Vacation Bible School Registration Form 06/24/19-06/28/2019
Will your child be ATTENDING VBS (ages 4-18) on June 24th-28th 6:30pm-8:30pm at CELEBRATION CHURCH at Monroe Street [301 N. Monroe Street, Baltimore, MD 21223]? Indicate on Drop Down Menu--->
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Yes
No
Will you be attending VBS with your Child?
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Yes
No
Select the NUMBER of CHILDREN ATTENDING From The Same Household (Siblings)
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1 Child
2 Children
3 Children
4 Children
5 Children
CHILD # 1: FIRST NAME, MIDDLE INITIAL & LAST NAME
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CHILD # 1: AGE & BIRTHDATE-- (e.g. Age-16 / Birthdate-2/10/1995)
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Please Make Sure To Fill Out Information For Each Sibling Living In The Same Household Below. If you do not have more than 1 child attending SKIP to section on form asking for: "FAMILY ADDRESS"
CHILD # 2: FIRST NAME, MIDDLE INITIAL & LAST NAME
CHILD # 2: AGE & BIRTHDATE-- (e.g. Age-16 / Birthdate-2/10/1995)
CHILD # 3: FIRST NAME, MIDDLE INITIAL & LAST NAME
CHILD # 3: AGE & BIRTHDATE-- (e.g. Age-16 / Birthdate-2/10/1995)
CHILD # 4: FIRST NAME, MIDDLE INITIAL & LAST NAME
CHILD # 4: AGE & BIRTHDATE-- (e.g. Age-16 / Birthdate-2/10/1995)
CHILD # 5: FIRST NAME, MIDDLE INITIAL & LAST NAME
CHILD # 5: AGE & BIRTHDATE-- (e.g. Age-16 / Birthdate-2/10/1995)
FAMILY ADDRESS
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PARENT/GUARDIAN Name (Note: If Guardian include relationship to Child -- e.g. Mary Jones (Aunt))
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PARENT/GUARDIAN Mailing Address (If same as Family Address above, type "SAME")
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PARENT/GUARDIAN Home, Cell & Work Phone Number (Please identify in the BOX BELOW each number e.g. HOME 123-436-7890/ CELL 321-456-7899/ WORK 410-567-0987)
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Does Your Child(ren) Have ALLERGIES? Type in Yes or No. If yes, what type?
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EMERGENCY CONTACT NAME:
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EMERGENCY CONTACT RELATIONSHIP TO PARTICIPANT:
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EMERGENCY CONTACT HOME, CELL & BUSINESS PHONE NUMBER (List below--e.g. Home 123-456-7890, Cell 456-987-9876, Business 531-567-8970)
Is permission granted in case of Emergency to TRANSPORT the PARTICIPANT to the CLOSEST/LOCAL HOSPITAL?
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Yes
No
PARTICIPANTS DOCTOR’S NAME AND TELEPHONE NUMBER:
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PLEASE LIST ANY MEDICAL CONDITIONS/MEDICATIONS YOUR CHILD (PARTICIPANT) IS CURRENTLY TAKING:
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By selecting Yes, I grant CELEBRATION CHURCH at Monroe Street permission to TAKE and USE PROMOTIONAL PHOTOGRAPHY and VIDEO.
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Yes
No
By selecting Yes, I agree that CELEBRATION CHURCH at Monroe Street RESERVES the RIGHT to WITHDRAW any PARTICIPANT whose conduct is deemed disruptive and/or harmful to peers, staff or volunteers.
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Yes
No
By selecting Yes, I agree that CELEBRATION CHURCH at Monroe Street CANNOT BE HELD LIABLE for personal injury, damage or loss of personal property.
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Yes
No
I Would Like to Donate Toward the Ministry of CELEBRATION CHURCH at Monroe Street in the Following Amount
$
Your Email Address
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Total
$
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