Living Hope ROAR VBS Registration 2019

June 24-28 ~ 8am-12pm | Please fill out this form and click submit.

Name

*

Gender

*

Please select one option.

Male Female

Age

*

Please select one option.

4 5 6 7 8 9 10 11 12

Last Grade Completed

*

Please select one option.

N/A Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade

Name of Parents:

*

Address

*

Parent / Caregiver Phone:

*

Parent / Caregiver Email:

*

This address will receive a confirmation email

Known allergies or other medical conditions (put N/A if none apply):

*

Emergency Contact Name:

*

Emergency Contact relationship to child

*

Emergency Contact Phone:

*

Authorized parties to pick-up child:

*

Additional Comments:

Photo/Video Permission

Photographs and videos are taken at Living Hope VBS. Some photographs and videos may be posted on Facebook or Instagram.

I (option selected) give permission for the image of this child to be used on the Living Hope Church Facebook and/or Instagram pages.

*

Please select one option.

Do Do Not

VBS T-shirts available to purchase and can be picked up as soon as two weeks before or at check-in.

VBS T-shirt payment

None (0) Pay by cash/check (0) Quantity 1 ($6) Quantity 2 ($12)

Amount

VBS T-shirt Size

*

Please select one option.

None X-Small (2-4) Small (6-8) Medium (10-12) Large (14-16) Adult Small (34-36) Adult Medium (38-40) Adult Large (42-44)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

June 24-28 ~ 8am-12pm

Please fill out this form and click submit.

Please Fix the Following

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