Please fill out the form below to register your child for our 2019 Vacation Bible School
 

Child's Full Name (required)

Child's Date of Birth(required)

Parent's Full Name (required)

Street Address (required)

City (required)

State (required)

Zipcode (required)

Your Email (required)

Phone Number (required)

Child's Age (required)

Child's Entering Grade (required)

Allergies or Medication (if any)

Can temporary tattoos be applied to your child?

Church Van pickup will be limited. Please advise if your child will need to be picked up (required)

Who will be responsible for picking up your child?

Any additional information you would like to provide

As a parent or legal guardian I hereby give my permission for him/her to participate in the One Community Church VBS program. In the event of an emergency, I also give permission to the directors of this VBS program to render First Aid, as well as the Physician selected by the adult leader to also render first Aid for any hospitalization, secure proper anesthesia, order injections, or secure medical treatment as needed.

I further agree to hold harmless the One Community Church Staff from any and all claims for damages arising out of personal injuries sustained by my son, daughter or ward, at any class time, play area, etc. and I hereby fully and forever release and discharge One Community Church Church staff from any and all said claims.

I understand photographs may be taken of my child for promotional use within the church and website.