VBS Adventure Bible Camp - Registration 2023

STEP 1: Please fill out this form and click submit.
STEP 2: After submitting, a pop-up window will appear. Click on the "payment" link to pay the $50 program fee.

Please fill out a separate form for each child.

Step 1 - Registration & Medical Release Form

Child Information

Name

CURRENT grade in school, please enter below

Grade

K4 Kindergarten 1st 2nd 3rd

T-Shirt size (children’s)

PRIMARY CONTACT INFORMATION

Primary Contact's first and last name

This address will receive a confirmation email

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.)

Step 2 - Payment (Registration Fee is $50.)

Once you click the submit button at the bottom of this form, a pop-up window with a link to our payment page will appear. At this point, you have the option of clicking the link to continue to pay online or you can pay by check. (Follow the instructions in the pop-up window.)

VBS Adventure Bible Camp - Registration 2023

Description

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