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City Life VBS Registration ( 1 form per child )
Event Dates: July 22nd - July 26th
Event Times : 6:00pm - 8:00pm
Event Address: 1300 17th ave w, Bradenton, FL 34205
Contact us at (941) 749-0288 or
info@experiencecitylife.com
Memory Verse:
"Be transformed by the renewing of your mind." Romans 12:2
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* Indicates required question
Email
*
Your email
Parent/Guardian Name
*
Your answer
Primary Contact Phone Number
*
Your answer
Child's Name ( FIRST & LAST )
*
Your answer
Gender
*
Male
Female
Child's Grade (most recent grade completed)
*
Choose
Pre -K ( 3,4,5, not in Kindergarten )
K- 1st
2nd -3rd
4th - 5th
T-Shirt Size (YOUTH SIZES) FREE VBS SHIRT FOR FIRST 50 CHILDREN TO REGISTER.
*
Choose
XS
YS
YM
YL
YXL
Medical Conditions / Allergies
*
Yes
No
If Yes to Medical / Allergies, Please explain
*
Your answer
Emergency Contact Information ( Name & Phone Number)
*
Your answer
I Give Permission for the following people to pick my child up, if I cannot.
*
Your answer
Medical Release : I give permission for my child to be treated by medical personnel in case of an emergency.
*
Yes
No
Required
Disclaimer: By attending City Life VBS I give permission for my child(ren) to be used for promotions / marketing on print and social media outlets.
*
I understand
Required
A copy of your responses will be emailed to the address you provided.
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