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2023 VBS Registration
June 13- June 15, 2023
Beach Lake FM Church, 107 Milanville Rd. Beach Lake PA, 18405
Contact us at 570-729-7544,
info@beachlakefmc.org
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Child's Last name, First
*
Your answer
Date of Birth
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MM
/
DD
/
YYYY
Grade Completed
*
Kindergarten
1st
2nd
3rd
4th
5th
Name of Parent or Guardian
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Your answer
Phone
*
Your answer
Email
*
Your answer
Address
*
Your answer
Home Church
Your answer
Emergency Contact Name, Phone Number and Relationship to Child
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Your answer
I agree to allow Beach Lake FM Church to use pictures or videos of my child in their advertising and promotion.
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Yes
No
Liability and medical release: The child listed on this form has my permission to attend and participate in Kids of the Kingdom VBS 2023 at Beach Lake FM Church. I release Beach Lake FM Church and its volunteers/employees from all liability for any injury that may occur while on the premises at this time. I hereby authorize Beach Lake FM Church to seek professional medical treatment if necessary. By checking this box I agree to the above statement.
*
Yes
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