VBS 2024 Participant Registration

Please fill out the pertinent information for your family and each child.
All children 3 years old through entering 5th grade (as of 9/1/24) are welcome! All 3 year olds who are potty trained and have experience in a school setting are welcome! Youth entering 6th grade and higher may fill out a volunteer form and be a youth helper!

One form may be used for one to five children living in the same household with the same parent or guardian. The ages and grades for VBS are based on what your child will be as of 9/1/24. Please read this form carefully and fill it out completely. All information provided will be kept confidential.

Parent Name

This address will receive a confirmation email

Parent 1 Cell

Parent 2 Cell

Home Phone

Address

Name - Child #1

Birthdate - Child #1

T-Shirt Size - Child #1

Allergies, etc. - Child #1

Does Child #1 Have an EpiPen with them? Yes No

Name - Child #2

Birthdate - Child #2

T-shirt size - Child #2

Allergies, etc. - Child #2

Does Child #2 Have an EpiPen with them?

Name - Child #3

Birthdate - Child #3

T-shirt size - Child #3

Allergies, etc. - Child #3

Does Child #3 Have an EpiPen with them? Yes No Option

Name - Child #4

Birthdate - Child #4

T-Shirt Size - Child #4

Allergies, etc. - Child #4

Does Child #4 Have an EpiPen with them? Yes No

Name - Child #5

Birthdate - Child #5

T-Shirt Size - Child #5

Allergies, etc. - Child #5

Does Child #5 Have an EpiPen with them? Yes No

Parent/Guardian- please read the following and initial in the boxes if you agree.

 In the event of an emergency where medical treatment is required, I give my permission to the church staff or sponsor to obtain the services of a licensed physician. Please attempt to notify me or my emergency contact immediately concerning any such emergency. I release Wildwood Presbyterian Church from liability regarding any such injury or illness.

 Pictures or video of groups of children/volunteers having fun at VBS may appear on the church's website or on social media (i.e. church’s Facebook or Instagram page), without names attached to the children. I grant permission for you to photograph/videotape my child. Specific privacy issues will be addressed by special request.

Emergency Contact: Please list the name, phone number and relationship for an emergency contact.

Does anyone else have permission to pick up your child(ren)? If so, please give names and phone numbers below.

For Children 4th grade and up or children with parents volunteering at VBS: Please initial here if you give your permission to release your child on his/her own without adult pickup.

Payment

Payment can be made in person or by mail with cash or check, or via credit card here. Please choose the appropriate option. An optional snack donation is appreciated but not required. If adding a snack donation, please pick "other" and type in the amount you're paying - the registration + snack donation.
June 2 or earlier- Discounted rate of $30 for the first child and $25 for each additional child with a max of $100 for the household.
June 3 or later - Full amount of $35 for the first child and $30 for each additional child,with a max of $120 for the household.

When paying by credit card there is an additional fee, as shown below.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

June 17-21, 2024, 9:00am - 12:00pm

Please submit this form in order to register participants for VBS 2024!

REGISTRATION FEES – SAVE BY REGISTERING EARLY!
Payment can be made in person or by mail with cash or check, or via credit card here at the bottom of this form. When paying by credit card there is a small additional fee.

June 2 or earlier- Discounted rate of $30 for the first child and $25 for each additional child with a max of $100 for the household.

June 3 or later - Full amount of $35 for the first child and $30 for each additional child, with a max of $120 for the household.

Additional snack donations are appreciated! You can add any amount onto the fee to help support our healthy snack fund.

Confidential scholarships are available from Becky Mosher at wpcbeckym@gmail.com or 847-223-0073.

VBS 2024 Participant Registration

Description

Please Fix the Following