VBA 2024 REGISTRATION

** Before filling this form out, please note that you will need to pay for your child/ren in order to complete the form. If you need a scholarship, please contact our VBA Director here before filling out the form. We don't want cost to prohibit any child from attending this year's amazing VBA!

Guardian Information

Parent/Guardian Name

Phone

Address

What church are you affliated with? Community Christian Fellowship Holy Trinity North Sound Church Other

Participating Children

Only fill out the necessary number of registrants (leave additional spots blank)

Child 1

First Name of 1st Child

Last Name of 1st Child

Date of Birth

Grade (going into the fall)

T-Shirt Size (children's sizes)

Allergies-Please list any allergies for your child (if none, say n/a).

Child 2

First Name of 2nd Child

Last Name of 2nd Child

Date of Birth

Grade (going into the fall)

T-Shirt Size (children's sizes)

Allergies-Please list any allergies for your child (if none, say n/a).

Child 3

First Name of 3rd Child

Last Name of 3rd Child

Date of Birth

Grade (going into the fall)

T-Shirt Size (children's sizes)

Allergies-Please list any allergies for your child (if none, say n/a).

Child 4

First Name of 4th Child

Last Name of 4th Child

Date of Birth

Grade (going into the fall)

T-Shirt Size (children's sizes)

Allergies-Please list any allergies for your child (if none, say n/a).

Child 5

First Name of 5th Child

Last Name of 5th Child

Date of Birth

Grade (going into the fall)

T-Shirt Size (children's sizes)

Allergies-Please list any allergies for your child (if none, say n/a).

Emergency Contact/Medical Waiver and Allergies

In Emergency, please contact:

Relationship to children:

Emergency Contact Phone

I do hereby consent to any medical care and the administration of anesthesia determined by a physician to be necessary for the welfare of my child while said child is under the care of Northsound Church, Community Christian Fellowship, and Holy Trinity Church, who are hosting Vacation Bible Adventure in the city of Edmonds, WA, and I am not reasonably available by telephone to give consent.

This authorization is effective from the 26^th day of June, 2024 to the 28^th day of June, 2024.

Emergency Medical Waiver Agreement-by checking this box you agree to the above statement.

Agree

Does your child require a medical device (i.e. Epipen, inhaler, insulin, etc.) for their allergy? If yes, the medical device must be sent in a plastic bag labeled with the child's full name

Yes No

Photo release-Are you okay with photos being shown of your child at the in-house end-of-the-day slideshow or in the take home hand out?

Yes No

If your child(ren) would like to be in the same group as a friend, please list your child's name first and the full name of their friend (Note: groups are by age and grade and we cannot guarantee placement in same group, but we will try).

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

VBA 2024 REGISTRATION

Description

Please Fix the Following