VBS Registration 2025

June 23-26, 9:00 - 11:00 am

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Primary Phone Number

Alternate Phone Number

Email

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Please list all adults permitted to pick up children

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

How many children would you like to register?

Number of Children

Child 1 Information

Child First Name

Child Last Name

Grade entering in 2025-2026 school year:

Birthdate

Age

Gender

List any allergies (or NA)

Additional Medical Information (or NA)

Child 2 Information

Child First Name

Child Last Name

Grade entering in 2025-2026 school year:

Birthdate

Age

Gender

List any allergies (or NA)

Additional Medical Information (or NA)

Child 3 Information

Child First Name

Child Last Name

Grade entering in 2025-2026 school year:

Birthdate

Age

Gender

List any allergies (or NA)

Additional Medical Information (or NA)

Child 4 Information

Child First Name

Child Last Name

Grade entering in 2025-2026 school year:

Birthdate

Age

Gender

List any allergies (or NA)

Additional Medical Information (or NA)

Child 5 Information

Child First Name

Child Last Name

Grade entering in 2025-2026 school year:

Birthdate

Age

Gender

List any allergies (or NA)

Additional Medical Information (or NA)

Release Statements

Medical Release: 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 release.

Signature

Date Input

Photograph/Video Release: Occasionally photos and 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.

Please indicate whether you agree with this photo/video release.

Yes

No