Registration Type
*
One Child
Family (Multiple Children)
How many children are you registering?
Please Select
2
3
4
5
Child Information
Child 1 Information
Child Name
*
First Name
Last Name
Age
*
Birthday
*
-
Month
-
Day
Year
Grade (just completed):
*
Please Select
PK3
VPK
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Please select your child's T-shirt size:
Please Select
Child X-Small
Child Small
Child Medium
Child Large
Child X-Large
Adult X-Small
Adult Small
Adult Medium
Adult Large
Adult X-Large
Does your child have any allergies?
*
Yes
No
Please list your child's allergies below:
Does your child have any medical concerns or special needs?
*
Yes
No
Please list your child's medical concerns and or special needs below:
Child 2 Information
Name
*
First Name
Last Name
Age
*
Birthday
*
-
Month
-
Day
Year
Grade (just completed):
*
Please Select
VPK
PK3
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Please select your child's T-shirt size:
Please Select
Child X-Small
Child Small
Child Medium
Child Large
Child X-Large
Adult X-Small
Adult Small
Adult Medium
Adult Large
Adult X-Large
Does your child have any allergies?
*
Yes
No
Please list your child's allergies below:
Does your child have any medical concerns or special needs?
*
Yes
No
Please list your child's medical concerns and or special needs below:
Child 3 Information
Name
*
First Name
Last Name
Age
*
Birthday
*
-
Month
-
Day
Year
Grade (just completed):
*
Please Select
VPK
PK3
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Please select your child's T-shirt size:
Please Select
Child X-Small
Child Small
Child Medium
Child Large
Child X-Large
Adult X-Small
Adult Small
Adult Medium
Adult Large
Adult X-Large
Does your child have any allergies?
*
Yes
No
Please list your child's allergies below:
Does your child have any medical concerns or special needs?
*
Yes
No
Please list your child's medical concerns and or special needs below:
Child 4 Information
Name
*
First Name
Last Name
Age
*
Birthday
*
-
Month
-
Day
Year
Grade (just completed):
*
Please Select
VPK
PK3
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Please select your child's T-shirt size:
Please Select
Child X-Small
Child Small
Child Medium
Child Large
Child X-Large
Adult X-Small
Adult Small
Adult Medium
Adult Large
Adult X-Large
Does your child have any allergies?
*
Yes
No
Please list your child's allergies below:
Does your child have any medical concerns or special needs?
*
Yes
No
Please list your child's medical concerns and or special needs below:
Child 5 Information
Name
*
First Name
Last Name
Age
*
Birthday
*
-
Month
-
Day
Year
Grade (just completed):
*
Please Select
VPK
PK3
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Please select your child's T-shirt size:
Please Select
Child X-Small
Child Small
Child Medium
Child Large
Child X-Large
Adult X-Small
Adult Small
Adult Medium
Adult Large
Adult X-Large
Does your child have any allergies?
*
Yes
No
Please list your child's allergies below:
Does your child have any medical concerns or special needs?
*
Yes
No
Please list your child's medical concerns and or special needs below:
Parent/Guardian & Emergency Contact Information
Primary Parent/Guardian Email
*
example@example.com
Parent/Guardian
*
Approved Pick-Up List (Only these individuals may pick up your child):
*
Photography Waiver
I give permission for my child(ren) to be in photos that are used in church communications.
*
Yes
No
Payment
Please check this box if you prefer to pay for your child(ren) in person, with cash or check, opening day of VBS at First Presbyterian Church of Lake Wales Florida.
I prefer in-person payment for my child(ren) using cash or check.
Number of Children Payment options:
prev
next
( X )
Single Child Registration
$
10.00
Two Children Registration
$
20.00
Three or more children
$
30.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Submit
Should be Empty: