VBS Adventure Bible Camp 2025 - Registration & Medical Release Form

Child Information (Pleas use Current Grade)

Name

CURRENT grade in school, please enter below

Grade

Pre-Kindergarten (K4) Kindergarten 1st 2nd 3rd

Birthdate

T-Shirt size (children’s)

PRIMARY CONTACT INFORMATION

Primary Contact's first and last name

This address will receive a confirmation email

Address

Enter the best contact number below:

Mobile

We really NEED and are very grateful for volunteers to help us—either for a few hours or every morning. If you would like to help in any way, please indicate below, and we will contact you.

Yes, I can volunteer as a daily leader/guide. THANK YOU! Yes, I can serve as a sub for a day or two. Please indicate which day/days on the next question. I am unable to help this week.

Please indicate day/days you could help. THANK YOU!

Medical Release for VBS Adventure Bible Camp at FPLC

Medical Release: In the event that I cannot be reached in an emergency, I give the program’s coordinator permission to secure and administer treatment, including hospitalization, for the child who is listed below:

Child's first and last name

Family physician

Physician's phone

Emergency Contact: In an emergency, if the primary contact is unavailable, who would you like us to contact? (Enter their first and last name.)

What is their relationship to your family?

Their mobile number

Child’s medication or environmental allergies

Dietary restrictions

Physical activity restrictions

I give the program’s coordinator permission to secure and administer treatment, including hospitalization, for my child who is listed above.

Yes, I give permission.

Today's Date

Primary Contact's signature (Enter first and last name as signature.)

Program Payment $75

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Su	Mo	Tu	We	Th	Fr	Sa
				1	2	3
4	5	6	7	8	9	10
11	12	13	14	15	16	17
18	19	20	21	22	23	24
25	26	27	28	29	30	31

VBS Adventure Bible Camp 2025 - Registration & Medical Release Form

Description

Please Fix the Following