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Camp Firelight Vacation Bible School @ First Presbyterian Church of Rockaway (June 24th - June 28th, 2024)
Registration Form
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* Indicates required question
Email
*
Your email
Child's Name
*
Your answer
Nickname/Preferred Name
Your answer
Parent/Guardian Name
*
Your answer
Address
*
Your answer
Telephone Number(s)
*
Your answer
Child's Age
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Other:
School Grade Entering
*
Your answer
Siblings
Your answer
Home Faith Community (if any)
Your answer
Emergency Contact (if parent/guardian cannot be reached)
Name, Telephone, Relationship to Child
*
Your answer
Allergies/Medical Needs (if none please put NONE)
*
Your answer
Person(s) authorized for picking up this child at the end of the day: Name(s) and Telephone Number(s)
*
Your answer
Anything special we need to know about your child?
Your answer
Shirt Size (indicate child/adult)
*
Your answer
One friend my child would like to be with:
Your answer
Special Needs classification & or circumstances
Your answer
We will be taking pictures during the week. We need your permission to take pictures of your child, put them on our PowerPoint Presentation for the final day, and our church website.
*
Yes
No
Signature (type)
*
Your answer
Payment (Due at Registration)
$25 per child or $60 per family
*
Check payable: First Presbyterian Church of Rockaway (35 Church Street Rockaway, NJ 07866)
Online Payment:
https://rb.gy/c4ncup
(Select VBS Registration Fee)
A copy of your responses will be emailed to the address you provided.
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