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CTK Breaker Rock Beach VBS Registration
Monday July 8, 2024- Friday July 12, 2024
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* Indicates required question
Email
*
Your email
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Last Grade Completed in School
*
PreK or TK
K
1
2
3
4
5
Age
*
Your answer
Parent's/Guardian's Name
*
Your answer
Address
*
Your answer
Home Phone Number
*
Your answer
Cell Phone Number
Your answer
Emergency Contact- Name and Phone Number
*
Your answer
Medical Concerns/Allergies
Your answer
Siblings At VBS
Your answer
People who may pick up your child
*
Your answer
Friend Request- If your child has friends that are attending VBS and are in the same grade that they wish to be in a group with please write their names below (2 only please). We will do our best to keep them together.
Your answer
I hereby grant the CTK VBS permission to photograph/film the minor above in any manner or form for any lawful use associated with this VBS program
*
Yes, I give my permission
No I do not give my permission
Required
If there is anything else you would like to tell us about your child that will help us minister to him/her please let us know below
Your answer
A copy of your responses will be emailed to the address you provided.
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