Scuba VBS Registration Form 2024

DIVE INTO GOD'S LOVE!
Immersed in oceans of fun, kids learn God is a real friend who loves them forever!

Scuba VBS at Neelsville Presbyterian Church
Dates/Times: Wednesday 7/10 through Friday 7/12 5:30-8:00 pm, Saturday 7/13 9:00 am-12:00 pm (+ family picnic and water play day), Sunday 7/14 worship service 10:30 am

Ages: 3 1/2 years by the start of VBS (and toilet-independent) through students who have completed 5th grade

How many children are you registering?

Child 1 Full Name

Child's Birthdate (Month/Date/Year)

Level child will have completed as of June 20, 2024

Preschool or PreK Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

T-shirt Size

Youth XS Youth S Youth M Youth L Youth XL Other (please specifiy in notes to Director below)

Child 2 Full Name

Child's Birthdate (Month/Date/Year)

Level child will have completed as of June 20, 2024 Preschool or PreK Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

T-shirt Size Youth XS Youth S Youth M Youth L Youth XL Other (please specifiy in notes to Director below)

Child 3 Full Name

Child's Birthdate (Month/Date/Year)

Level child will have completed as of June 20, 2024 Preschool or PreK Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

T-Shirt Size Youth XS Youth S Youth M Youth L Youth XL Other (please specifiy in notes to Director below)

Please list any allergies, medical conditions, or special needs that would help us to best care for your child(ren). Kindly indicate which child(ren).

Is there anything else you would like the Director to know?

Address

Parent/Guardian 1 Name

Parent/Guardian 1 Email

This address will receive a confirmation email

Parent/Guardian 1 Phone

Parent/Guardian 2 Name

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

Emergency Contact: Please list first name, last name, and phone number for someone besides the listed parents or guardians.

Please list anyone besides parents/guardians who has permission to pick up your child.

Do you give permission to Neelsville Church to use photos of your child for website, social media, or other promotional use? Please note that we will never post children's names to respect privacy.

Yes No

What church do you attend? If you don't attend church, please write "none."

Would you like to receive our weekly e-newsletter with updates on Neelsville Presbyterian Church and its Children's Ministry?

Yes, please. No, thank you. I'm already receiving these updates.

By typing my first and last name and today's date, I hereby release Neelsville Church from liability and hold the church and its representatives harmless for the duration of The Scuba VBS Program.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Scuba VBS Registration Form 2024

Description

Please Fix the Following