VBS Registration

2023 Vacation Bible School Registration

Parent Name(Required)

First Last

Phone(Required)

Best daytime contact number

Email(Required)

Your email address

Home Church

Optional

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Best Daytime Phone number

Emergency Contact - Relationship

Spouse

Parent or Grandparent

Friend

Who may pick up your child (children) after VBS?(Required)

Name

How many children are you registering for VBS?

Child 1

Child's Name(Required)

Last Grade to Be Completed Before VBS(Required)

Date of Birth(Required)

Allergies

Child 2

Child's Name

Last Grade to Be Completed Before VBS

Date of Birth

Allergies

Child 3

Third Child's Name

Last Grade to Be Completed Before VBS

Date of Birth

Allergies

Child 4

Fourth Child's Name

Last Grade to Be Completed Before VBS

Date of Birth

Allergies

Child 5

Fifth Child's Name

Last Grade to Be Completed Before VBS

Date of Birth

Allergies

How did you hear about our VBS?

Acknowledgement(Required)

I agree.

By submitting this online registration, I hereby acknowledge and agree that I am placing my child in the care of Emmanuel OPC for the purpose of their VBS program and in so doing I agree to, and hereby do release Emmanuel OPC and their staff from any and all liability for any incident, accident or occurrence which may take place involving my child, including but not limited to any resulting injury or illness which my child may suffer as a result of attending VBS at Emmanuel OPC.

2023 Vacation Bible School Registration

Child 1

Child 2

Child 3

Child 4

Child 5

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