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DISCLAIMER

REGISTER ONLINE

VBS 2010 REGISTRATION FORM
Johnson City Primitive Methodist Church

 

REGISTRATION DISCLAIMER:

 

By completing this registration form, you hereby agree to the following:

As parent/guardian of the child(ren) listed below, I release the Johnson City Primitive Methodist Church and all volunteers associated with the Vacation Bible School program from any and all liability to the child(ren) named below during his/her/their attendance at all VBS activities. Should any injury occur, I give my permission for first aid treatment to be given and for any doctor or hospital personnel to render emergency medical treatment as is deemed necessary.


Name of Parent completing form:*
Number of Children you are registering (max. 5 per
online form):
*
Email Address*
Mailing Address*
City, State, ZIP*
Street Address (if different than above)
Phone number*
Transportation:*
Drop-off / Pick-up 
Walk / Bike 
Church Van Requested (space may be limited; please provide a booster seat for anyone under 8 years old) 
Child coming with VBS Staff member 
Emergency Contact Name (other than you):*
Emergency Contact Phone (other than yours):*
Names of anyone authorized to pick up child(ren):*
Name of Child (1):*
Gender*
Boy 
Girl 
Date of Birth*
School Grade Completed*
Name of Child (2):
Gender
Boy 
Girl 
Date of Birth
School Grade Completed
Name of Child (3):
Gender
Boy 
Girl 
Date of Birth
School Grade Completed
Name of Child (4):
Gender
Boy 
Girl 
Date of Birth
School Grade Completed
Name of Child (5):
Gender
Boy 
Girl 
Date of Birth
School Grade Completed
Does child(ren) currently attend church?*
Yes 
No 
If YES, where?
Has child(ren) attended VBS at Johnson City
Primitive Methodist Church before?
*
Yes 
No 
How did you hear about this year's VBS? (select
ALL that apply)
*
I attend this church 
Referred by friend / relative 
VBS Website 
Flier from school 
Newspaper / Other media 
Mailing 
Yard signs at church 
Yard signs around area 
IMPORTANT! Are there ANY food allergies and/or
health concerns of which VBS Staff should be
aware?
*
Yes 
No 
If YES, please provide details:

After clicking the "Submit Form" button above, you should receive a copy of the Online Registration Form at the email address you provided.  If not, please contact VBS Director by clicking:  

____________________

Online Registration Form provided by EmailMe Form.com - THANK YOU!

They can be accessed at the link below:

EmailMe Form

2010 Johnson City Primitive Methodist Church

Sharing God's love in Christ to you
and through you to the world.

____________________

VBS 2007

VBS 2010 - Johnson City Primitive Methodist Church Vacation Bible School
EASTER . . . the Rest of the Story
Publisher: Johnson City Primitive Methodist Church
Johnson City, New York