Event registration
Event Timing: July 8-12  9:30 am to 11:30 am
Event Cost: $10/child ...link to pay at the end of the registration form
Event Address: 16 McVicar St. Red Deer, AB
Contact us at 403-346-5659  firstcrcvbs@gmail.com
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Email *
Email *
First Name of Child *
Last Name of Child *
Street Address/P.O. Box *
City/Town *
Province *
Postal Code *
Child's Date of Birth *
Current Age of Child *
Grade Your Child will enter in the fall *
Parent #1 Name *
Parent #1 Phone Number *
Parent #2 Name *
Parent #2 Phone Number *
Emergency Contact #1 *
Emergency Contact #1 Phone Number *
Emergency Contact #2 *
Emergency Contact #2 Phone Number *
Does your child have any allergies *
If you answered "Yes" to allergies please specify below
Does your child have any behavioral concerns? If so please provide details below. *
Are you affiliated with a church? If so please specify which one.
Is there a friend your child wishes to be paired with?  If so please provide their full name. We will do our best to accommodate the request. 
Please select which options below to grant permission for the reasonable use of pictures containing your Child in the following ways: *
Required
*Please read* The safety of your child is our primary concern. Precautions will be taken for their well-being and protection. I, named below, undertake and agree to indemnify and hold harmless program personnel, First Christian Reformed Church, Red Deer and its leaders from and against any loss damage, or injury suffered by the participant as a result of being a part of the activities of First Christian Reformed Church, Red Deer. This consent and authorization is effective only when participating in events sponsored by First Christian Reformed Church, Red Deer. Please sign below to indicate your agreement with the above statement. *
Registration payment - $10 per child
Registration confirmed once payment received
Please select VBS as donation fund
Once payment is made go back to this form to submit.
Payment made?
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