RPC - VBS Home

Register for VBS!

If you have any questions or comments, please feel free to contact us.

Parent's Name:
Address:
City/State/Zip:
Phone/Email:

Emergancy Contact:
Relationship to child:
Home Phone:
Alt. Phone:
Family Doctor:
Doctor Phone:
Does your child require special accommodations or an aide?:	Yes \|\| No

Home Church:
How did you hear of our VBS?:

1st Child Name:
Age:
Last Grade Completed:
Allergies/Medical:

2nd Child Name:
Age:
Last Grade Completed:
Allergies/Medical:

3rd Child Name:
Age:
Last Grade Completed:
Allergies/Medical:

4th Child Name:
Age:
Last Grade Completed:
Allergies/Medical:

Comments I hereby enroll and give permission for my child to participate in the planned activities of Vacation Bible School (VBS) at Reformed Presbyterian Church. I understand that I am responsible for transportation to and from VBS each day. The above health history is correct as far as I know and the child(ren) described has permission to engage in all VBS activities except as noted. In the event I cannot be reached in an emergency, I hereby give permission to the medical personnel selected by the VBS director to order X-rays, routine tests, treatment, hospitalization and necessary related transportation for my child(ren) until such time as I am available. Photograph release: I understand that unless specifically stated in writing at the time of registration, photos/slides/videotaping of my child(ren) may be taken. I realize that our right to privacy will be protected in all photographs and publications of the VBS activities. I understand that no personal information other than name, hometown and congregation will be released under any circumstance, and this meets my approval. If registering online, please print your name on the signature box. This will serve as your signature.
Signature of Parent or Guardian:
Date: