Mercy Springs 2020 Student Registration
Early Bird Registration Currently Open ~ Reserve you child's spot today! 🐴 🌵☀️

July 13th - 17th | 9:00am - 11:45pm
CBC Kids Vacation Bible School
$20/Child | $15 per additional children
T-K to 5th Grade | Limited Spaces Available

PAYMENT OPTIONS
$20/Child | $15 per additional children

1. Check - Payable to Community Bible Church, Ventura; "VBS" in description. Drop off at, or mail to: 5040 Telegraph Road, Ventura, CA 93003. We use the name and address information printed on the check to send you a receipt at the end of the year for your tax deduction. (The IRS requires that a receipt is issued to the person whose name is on the check.)
2. Cash - Drop off at Community Bible Church.
* Unfortunately, online payment is not currently available. *

Your Registration will be complete once payment has been completed. Please complete one (1) form per child. Scholarships available.

Thank you so much for signing up for Mercy Springs with CBC Kids! We understand summer can be a busy time for camps, vacations, and beach days - we are so glad you can join us for a meaningful week of activities, stories, and fun.

For more information, please contact Katherine Nofziger at katherine@cbcventura.org or (805) 218-4133.
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Email *
Student First Name *
Student Last Name *
Gender *
Birthdate *
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Child Shirt Size *
Required
Student will enter this grade in Fall 2019 *
Parent/Guardian name(s) *
Home Address: Street Address *
Home Address: City, State, ZIP *
Phone number *
My child is authorized to be picked up by the following people: *
Emergency contact name *
Emergency contact's relation to child *
Emergency contact's phone number *
Student: Allergies, medical condition or other important information *
If you are in need of a scholarship, please enter an amount below. Otherwise, leave blank.
Authorization: If my child is injured in an accident or becomes seriously ill, and I or my designee cannot be reached, I authorize Community Bible Church to arrange for the transportation of my child to a licensed emergency medical care facility to receive prompt treatment. Furthermore, I authorize the medical personnel at the facility to provide such treatment to my child as is indicated by the nature and extent of his or her injury and that is in accordance with the protocols of standard medical practice. Finally, I accept full financial responsibility, for all costs, charges, and fees associated with the transportation of my child and for the treatment provided by the medical care facility to my child and absolutely and unconditionally agree to indemnify and to hold Community Bible Church harmless from all such costs, charges, and fees. By selecting below, I agree to the above statements. *
Required
Parent/Legal Guardian Name *
Date *
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Signature, Date (Sign in person)
A copy of your responses will be emailed to the address you provided.
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