VBS Participant Registration Form 2024 - GLOW

*One form per child* VBS is for children 4 years old through completed 5th grade June 17-21, 6:15-8:30 pm

Your name *

Email address *

Child's Info

Child's Name *

Gender *

Age *

Date of Birth *

Last Grade Completed *

Parent(s) *

Address *

Phone number *

Phone number

T-Shirt Size *

Emergency Contact

Emergency Contact - Non-Parent/Guardian *

Phone number *

Emergency Contact - Non-parent/Guardian

Phone number

Authorized Pickup #1

Authorized Pickup #2

Do you regularly attend CCC?

Allergies or other medical conditions *

If there are none, type "N/A"

Parent/Guardian Digital Signature *

Photo Release: I acknowledge that there will be photos/videos taken during VBS activities, and I hereby grant my permission for such photos/videos to be taken and to be used in church publications.
*PLEASE WRITE YES OR NO*