VBS 2023 Registration

Parent/Guardian Information

1. Parent/Guardian Name

Phone Number

2. Parent/Guardian Name

Phone Number

This address will receive a confirmation email

Address

Please list all adults permitted to pick up children.

Child 1 Information

Child 1 Name (First / Last)

Child 1 Gender

Child 1 Age

Child 1 Grade entering into 2023/2024 school year:

Child 1 Allergies/Medical Issues or Concerns

Child 2 Information

Child 2 Name (First / Last)

Child 2 Gender

Child 2 Age

Child 2 Grade entering into 2023/2024 school year:

Child 2 Allergies/Medical Issues or Concerns

Child 3 Information

Child 3 Name (First / Last)

Child 3 Gender

Child 3 Age

Child 3 Grade entering into 2023/2024 school year:

Child 3 Allergies/Medical Issues or Concerns

Child 4 Information

Child 4 Name (First / Last)

Child 4 Gender

Child 4 Age

Child 4 Grade entering into 2023/2024 school year:

Child 4 Allergies/Medical Issues or Concerns

Child 5 Information

Child 5 Name (First / Last)

Child 5 Gender

Child 5 Age

Child 5 Grade entering into 2023/2024 school year:

Child 5 Allergies/Medical Issues or Concerns

Emergency Contact

Emergency Contact Name

Emergency Contact Phone Number

Relationship to Child

2023 CTR Waiver

Medical: In the event of a medical emergency and when a contact cannot be made in a timely manner to me and/or the emergency contact listed, I give my permission for my child(ren) to receive appropriate medical attention. In the event of an unforeseen emergency or any accidents, I release Christ the Redeemer, its employees and volunteers, and all those related to it, from any liability. I have provided emergency contact numbers and am assured that I will be contacted as soon as possible in the event that there is an emergency.

I agree with the above releases.

Photograph release: Occasionally photos & videos may be taken during VBS. I grant permission for Christ the Redeemer Church to use photos and videos including my child(ren) in church publications.

Yes No

By typing my first and last name, I agree with the above releases.

Date of agreement

This is a FREE event.

VBS 2023 Registration

Description

Please Fix the Following