VACATION BIBLE SCHOOL - 2010

Shoreline Baptist and Calvary Baptist - Huntington Beach
Together for the Glory of God present:

 

Vacation Bible School 2010
Enrollment Form

July 12 - 16th, 2010, 8:45 a.m. - 12:00 noon

Vacation Bible school is open to all students who have completed kindergarten through completed 5th grade in June.

VBS Fee: $15.00 - Includes VBS T-Shirt, snacks, craft and other materials/supplies.

You may sign up online and bring the $15 to the church office or pay the first day of VBS.

If you have any questions please contact the church office or Zaida Cutler.

Parent/Guardian Information:

Name:
Address (line 1):
Address (line 2):
City:
State:
Zip:
Daytime Phone #:
Secondary Phone #:
E-mail Address:

Emergency Contact Information: In case of emergency, should we be unable to reach you, please list additional contact information:

Name (and relationship):
Phone #:

Church Information:

Where do you regularly attend Church/Sunday School?
Are you helping with VBS?* Yes  No
How did you hear about our VBS?
*Child-care available for workers for infant through 4 years of age

Child Information:

Please include any of the following physical conditions your child has in the "Medical information" box for each child. Also indicate if your child CANNOT participate in recreation.

Allegries ~ Asthma ~ Heart condition ~ Diabetes ~ Ear, Eye, Nose or Throat ~ Epilepsy ~ Other

Child #1 Information:

 

Name:
Birthdate:
Grade Completed in June:
Medical or any other information we need to know (please include any allergies):

Child #2 Information:

Name:
Birthdate:
Grade Completed in June:
Medical or any other information we need to know (please include any allergies):

Child #3 Information:

Name:
Birthdate:
Grade Completed in June:
Medical or any other information we need to know (please include any allergies):

Child #4 Information:

Name:
Birthdate:
Grade Completed in June:
Medical or any other information we need to know (please include any allergies):

Questions/Comments:

Please enter any questions or comments in the box below.

Permissions:

Name of any person NOT authorized to pick up your child:
                              

I give my permission to the VBS staff of Calvary Baptist Church and/or Shoreline Baptist Church to give medical treatment to my child, and to call emergency services if necessary.

ELECTRONIC SIGNATURE:   please write your full name in the Electronic Signature box signifying your give your permission for medical treatment.

PLEASE NOTE:  Calvary Baptist Church and/or Shoreline Baptist Church will be taking photos of your child.  We reserve the right to use any type of audio and/or visual records in our VBS program for promotional and/or commercial purposes with no compensation to parents.

Please click submit only once.  It may take up to 1 minute to process.

  

10350 Ellis Avenue · Fountain Valley, CA 92708 · Ph 714.968.4222
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