VBC 2022 Reg Form

Little Falls Presbyterian Church Vacation Bible Camp 2022 Online Registration Form

VBC dates are July 11-15, 2022. There are 4 parts to the form: (1) Registration information for each child participating; (2) Parent/Guardian & Volunteer Information; (3) Medical/Insurance Information; and (4) Payment. Please be sure to complete the form in its entirety or it may delay processing and acceptance into VBC. All information provided is kept strictly confidential. If you have any questions or need assistance, please email Office@littlefallschurch.org.
PART 1: CHILD(REN)'S INFORMATION
CHILD #1: CHILD'S NAME: *

First Name Last Name
Child #1 Birth Date *

Month Day Year
Child #1 Fall 2022 Grade *
Child #1 Gender
Child #1 T-shirt Size (youth sizes) *
Child #1 Allergies (If none, please type "None" as this is a required field): *
If Child #1 has any food allergies or dietary restrictions, do you plan to send a snack with your child?
My child (Child #1) would like to be placed in the same group with First Name Last Name. Please note that we do our best to accommodate this request but cannot guarantee it. Remember that part of the camp experience is learning how to make new friends!
If you have more than one child, please proceed below, otherwise skip to PART 2 (PARENT/GUARDIAN/VOLUNTEER INFORMATION).
CHILD #2: CHILD'S NAME:

First Name Last Name
Child #2 Birth Date

Month Day Year
Child #2 Fall 2022 Grade
Child #2 Gender
Child #2 T-shirt Size (youth sizes)
Child #2 Allergies (If none, please type "None" as this is a required field):
If Child #2 has any food allergies or dietary restrictions, do you plan to send a snack with your child?
My child (Child #2) would like to be placed in the same group with First Name Last Name. Please note that we do our best to accommodate this request but cannot guarantee it.
CHILD #3: CHILD'S NAME:

First Name Last Name
Child #3 Birth Date

Month Day Year
Child #3 Fall 2022 Grade
Child #3 Gender
Child #3 T-shirt Size (youth sizes)
Child #3 Allergies (If none, please type "None" as this is a required field):
If Child #3 has any food allergies or dietary restrictions, do you plan to send a snack with your child?
My child (Child #3) would like to be placed in the same group with First Name Last Name. Again, we do our best to accommodate this request but cannot guarantee it.
PART 2: PARENT/GUARDIAN/VOLUNTEER INFORMATION
Parent/Guardian Name *

First Name Last Name
Address (location where child resides) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian E-mail *
Parent/Guardian Phone Number *
Child's home church, if applicable:
Alternate Contact (if above parent/guardian cannot be reached): *

First Name Last Name
Alt. Contact Relationship to Child: *
Alt. Contact Phone Number: *
Priority for camp acceptance is given to children whose parents (or guardians, nanny, older sibling, grandparents, etc) can volunteer with us that week. (Volunteers must be a rising 6th grader or older). Can you (or a nanny, grandparent, aunt/uncle of child, etc.) volunteer at camp? FREE childcare is provided for volunteers with children too young to attend camp. *
If YES, please list the name of the person available to volunteer:

First Name Last Name
Volunteer's Email
Volunteer's Phone
Our top priority is filling Crew and Station Leader volunteers. Please consider assisting in either of those capacities. You can read the descriptions of all volunteer positions on the VBC Volunteer website page. Please indicate below your first and second choices.
Volunteer's T-shirt size
PART 3: MEDICAL INFORMATION
Name of Medical Insurance Provider: *
Medical Insurance Policy Number: *
Name of family doctor/pediatrician: *
Doctor/Pediatrician Phone Number: *
I, the undersigned, am the parent/legal guardian of the child(ren) listed on this form and give permission for my child(ren) to participate in Little Falls Presbyterian Church’s 2022 Vacation Bible Camp (VBC). I will not hold the church or leaders serving during VBC legally responsible for any injury to my child(ren). In the event of an emergency, I give my consent and authorization for securing qualified medical treatment for my child(ren) if I cannot be reached. I consent for my child(ren) to be photographed and recorded, and for any media featuring my child(ren) to be used for the purposes of church publicity. I understand that if I cancel my child(ren)'s registration for any reason after I have registered, I will not be refunded. *

Clear
Date *

Month Day Year
PART 4: PAYMENT
Choose ONE option below: *
prev next ( X )
VACATION BIBLE CAMP: 1 Child ($60 total)
$ 60.00

VACATION BIBLE CAMP: 2 Children ($115 total)
$ 115.00

VACATION BIBLE CAMP: 3 Children ($160 total)
$ 160.00

I am bringing payment (cash or check only) directly to the church Cash or check must be received no later than 5 days from today or your registration will be canceled.
Free

Total

$ 0.00
Should be Empty:

Little Falls Presbyterian Church Vacation Bible Camp 2022 Online Registration Form

PART 1: CHILD(REN)'S INFORMATION

If you have more than one child, please proceed below, otherwise skip to PART 2 (PARENT/GUARDIAN/VOLUNTEER INFORMATION).

PART 2: PARENT/GUARDIAN/VOLUNTEER INFORMATION

PART 3: MEDICAL INFORMATION

PART 4: PAYMENT