YeeHaw! MyChurch 2019 VBS Registration

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Dates: June 3th-6th, 2019, 6:30 - 8 pm each night
Location: Sahuarita Lake Park, 15466 S. Rancho Sahuarita Blvd, Sahuarita, AZ 85629
Contact: website@mychurchaz.com

Email *

Student Name (First) *

Student Name (Last) *

Date of Birth *

YYYY

Gender *

Male

Female

Grade Entering in Fall 2019 *

(NOTE: If child is 3 years old, a parent or guardian must stay with the child)

Home Church

Primary Parent/Guardian *

This is the first person we will contact in case of emergency

Mother

Father

Other:

Primary Parent/Guardian Name *

Primary Guardian Contact Phone Number During VBS *

Address *

Secondary Emergency Contact *

This is the second person we will contact if the primary contact is not able to be reached.

Mother

Father

Other:

Secondary Emergency Contact Name *

Secondary Emergency Contact Phone Number *

Do you have a friend you would like to be placed with? If so, who?

Allergies/Special Needs/Additional Notes

PARENTAL RELEASE AND WAIVER AGREEMENT *

By completing and submitting this form: I consent for my child to participate in the activities of MyChurch and voluntarily and absolutely release MyChurch from all liability for personal injury and/or damage as a result of engaging in any activities of MyChurch. I authorize and give full consent to MyChurch to use on their website all photographs in which I/my child appear while involved in ministries of MyChurch.

I Agree

Required

Send me a copy of my responses.

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