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Contact information
CBC VBS / Summer Camp Registration - 2023
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Email
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Your email
Last name
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First name
*
Your answer
Parents'/guardians' names
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Your answer
Gender
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Female
Other:
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Names of siblings attending
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Allergies or other medical conditions (if applicable)
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Birthdate
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MM
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DD
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Grade in September
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Address (street address, town, postal code)
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Home phone number
*
Your answer
Cell phone number of parent
*
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Parent’s email address
*
Your answer
Name and phone number of contact person for the week of VBS
*
Your answer
Name of person picking up child at the end of each day
*
Your answer
Alternate name and phone number for emergencies
*
Your answer
Child’s health card number (optional)
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Name of home church (if applicable)
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My child has permission to attend VBS/summer camp and have their picture taken for assembly slideshow
*
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Parent signature (type initials)
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Date of form completion
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DD
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YYYY
Other comments
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