Church of Christ on Country Club Road HayDay VBS 2022
Thank you for joining us for our 2022 Vacation Bible School!
June 4, 2022 9:30am-3:00pm
ages 3 (must be fully potty trained)-entering 6th grade
If you have more than one child coming, please fill out a separate form for each child.
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What is your child's first and last name *
Age/Year entering in school *
Parent(s) Full name *
Parent's Phone number *
Parents Full Address *
Parents email address *
Emergency Contact Name *
Emergency Contact Number *
Authorized pickup Name(s) and phone numbers (please separate entries by a ';'). The person picking up your child will be required to show identification. *
Example: John Smith- 2145786541;
Please list any allergies your child has. (If none, put n/a) *
Please list any medications your child takes that we need to be aware of. (If none, put n/a) *
Does your child have any special needs? Please explain. (If none, put n/a) *
May we photograph your child for church use only? (We will not post these pictures on social media) *
I hereby give Permission for my child to participate in VBS activities, and agree to accept full financial responsibility for any medical treatment for my child.  I further understand that in the event that my child requires medical treatment while engaging in these activities, reasonable efforts will be made to contact me. However, if I cannot be reached, I hereby give consent and give permission to the church’s sponsors to consent to any medical treatment for my child. I hereby release the Church of Christ on Country Club Road, and its employees, members and sponsors from all liabilities and damages for personal injury or illness to my child. *
How did you hear about our VBS?
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