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VBS 2024 Registration Form
August 5th-8th 9:30am to Noon K-5th
*
Indicates required field
Parent/Guardian Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Email
*
Others Authorized for Pick Up
*
EMERGENCY CONTACT (name & phone)
*
Children Registration
Child #1
*
First
Last
Birth Date
*
Grade
*
Allergy
*
Medications epi-pen/inhalers
*
Child #2
*
First
Last
Birth Date
*
Grade
*
Allergy
*
Medications epi-pen/inhalers
*
Child #3
*
First
Last
Birth Date
*
Grade
*
Allergy
*
Medications epi-pen/inhalers
*
Child #4
*
First
Last
[object Object]
Birth Date
*
Grade
*
Allergy
*
Medications epi-pen/inhalers
*
Child #5
*
First
Last
[object Object]
Birth Date
*
Grade
*
Allergy
*
Medications epi-pen/inhalers
*
Name
*
First
Last
Birth Date
*
Grade
*
Allergy
*
Medications epi-pen/inhalers
*
If you have more then 6 Children that need to be signed up please fill out another Online registration form.
Media Release
*
By checking this box, I grant permission to North Rome Wesleyan Church to take images/video of my child, during Children Ministry activities for the sole purposes of training, promotion, & publications including Facebook posting, & waive any rights of compensation. I understand that my child/children's name(s) will not be published with the images.
I do not grant permission for the above statement.
SIGNATURE of Parent/Legal Guardian
*
By typing my name I am Signing this form and giving my consent all information is accurate.
Submit