2024 VBS Registration Form

Please complete the form below (One FORM per CHILD)

Child's Information

First Name

Last Name

Shirt Size

Grade

Date Of Birth

YYYY

Child's Age

Child’s Gender:

Male

Female

Name of Parent(s)

First Name

Last Name

Cell Phone

(###)

###

####

Backup Phone #

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Church

Are parent(s) helping with VBS?

Yes

If yes, where are they helping?

VBS (Vacation Bible School) Waiver: I, the under signed parent/guardian of the above named child do hereby consent to his/her participation in VBS at Cornerstone Community Church (C3). I agree to waive and release (C3) and its volunteers from all claims for damages that may arise, as a result of my child’s participation in VBS. I am aware that the above named child may appear in a photographs, or videos, taken by VBS staff, and that photographs or videos may be used. I acknowledge and confirm that I have read this entire document before typing my name below.

Please type your name as your signature.

Type Today's Date

YYYY

In Case of Emergency, Please Contact

First Name

Last Name

Phone

(###)

###

####

Relationship to Child

Allergies or Other Medical Conditions

(Please be Specific)

Any questions let us know…

Looking forward to a great VBS!!

Questions will be forwarded to our VBS Director Kylee.

Name

First Name

Last Name

Subject

Message

2024 VBS Registration Form

Please complete the form below (One FORM per CHILD)

Any questions let us know…

(760) 356-1061 • CONTACT@C3HOLTVILLE.ORG