Child's Name:
Age:
LAKESIDE COMMUNITY PRESBYTERIAN CHURCH
SONQUEST RAINFOREST
VACATION BIBLE SCHOOL (VBS) July 12th ‑ 16th
REGISTRATION FORM
Please use a separate form for each child enrolled in the program
Birth Date:
Grade in Sept. 2010:
Preschool
Kindergarten
1st
2nd
3rd
4th
5th
Parent's Name:
Daytime Phone:
ext:
Address:
City:
State:
Zip:
Email:
Emergency Contact:
Daytime Phone:
ext:
(Opt.) Alternate Contact:
Daytime Phone:
I will pick up my child.
will pick up my child.
Does your child have special needs we should be aware of?
Any health problems/allergies/drug reactions?
Date of last tetanus shot:
Medical Insurance Carrier:
Policy Number:
T‑Shirt Size: (Children's Sizes
Small
Medium
Large
X_Large
(one free with paid registration)
Do you regularly attend church
No
Yes
, at
Has your child attended our Vacation Bible School (VBS) program in previous years?
No
Yes
How did you hear about our VBS program?
Attended VBS in previous year(s)
Heard about it from a friend
Flyer that came home from school
Radio announcements
Posters around town
Other
School attended: (select one)
Lakeside Farms
Lakeview
Lemon Crest
Lindo Park
LCPC Preschool
Riverview
Wintergardens
Other
I give my permission for the minor named above to attend Vacation Bible School at Lakeside Community Presbyterian Church from July 12 ‑ 16, 2010. In case of a medical emergency, I hereby give permission to the physician selected by the program director to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for the minor named. (Every reasonable effort will be made to contact you first.) In case of accident or injury, I will not hold the church or it's staff and volunteers liable.
Please note:
The above information will be sent to our server for further processing after clicking the
submit
button, below. Submission
does not complete
the registration process. Photo and Medical Release forms must be completed and delivered to the Church office, along with registration donation for the process to be completed. If a valid email address was submitted, a confirmation email will be sent, along with the amount for the suggested enrollment donation. The electronic date of submission will determine the appropriate donation amount, as outlined in the preceding VBS information page.
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