2022 Rocky Railway VBS Registration
VBS is open to children 4 years of age through 5th grade (entering 5th grade in the Fall).

Dates:  July 11 - July 15, 2022; 9:00am - Noon
Cost: $45/child; maximum $150/family (includes t-shirt, snacks, crafts, & games)
No refunds can be provided since all materials for VBS are purchased in advance.
Address: 13950 Peach Hill Rd, Moorpark, CA 93021
Contact: Kami Fair at (805) 529-8422 x105  or KamiF@MPCLife.org for any questions.

* All children must be age 4 and fully potty-trained by June 1, 2022 to participate in VBS.
* VBS is open to children 4 years of age through 'entering 5th grade in the Fall'.
* OPTIONAL: You may purchase the VBS "Sing & Play Express Music Download Card" (digital version) at GROUP.com if your family would like to enjoy the music outside of the VBS program.
* Your child(ren) will be placed with other children of the same age.  We will make every effort to place your child(ren) with at least one friend as requested on this form.
* More details about VBS week (including group/crew assignments) will be sent directly to your email closer to the VBS date.
PLEASE COMPLETE THIS FORM SEPARATELY FOR EACH CHILD.  THANK YOU.
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Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Relation to Child *
Parent/Guardian Email *
Parent/Guardian Cell Phone Number *
Street Address *
City, State, Zip *
Emergency Contact First & Last Name *
Emergency Contact Relation to Child *
Emergency Contact Cell Phone Number *
Who can pick up your child? PROVIDE FULL NAME AND CELL PHONE NUMBER. *
Name of home church *
Name of child *
Gender of child *
Date of birth of child (must be 4 and fully potty-trained by 6/1/22 please). You can enter date manually. :) *
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Current Grade (Grade Completed in '21-'22 school year) *
Allergies or medical concerns for child *
T-shirt size for child *
Please give the full name of a friend your child would prefer to be in a group with.  We will do our best to accommodate this request.  Our groups are set up by age. *
Are you available to volunteer at VBS?  You can go to MPCLife.org/2022-vbs-volunteers to see the opportunities & to sign up.  Youth volunteers (entering 7th grade and higher in the Fall) may also volunteer and receive service hours. *
How many children are you paying for with this submission? ($45/child with $150 max/family).  No refunds available since all supplies are purchased in advance. *
MEDIA LIABILITY RELEASE: I hereby grant permission for Moorpark Presbyterian Church (MPC) to record sound, images or video of my child while attending the VBS program.  I also give permission to MPC at its sole discretion to use these sounds, images, or videos in publications (including print, websites, and social media platforms) owned by MPC in relation to this VBS program.  MEDICAL LIABILITY RELEASE: In the event of an emergency requiring medical treatment, I hereby give permission to the licensed medical professional and/or hospital/medical facility chosen by Moorpark Presbyterian Church (MPC), to treat, transport, and hospitalize my child.  I understand that my child may be transported by van, ambulance or private vehicle.  I hereby release MPC, its staff and/or volunteers of the liability for injury and/or transport and I assume all risk stemming from my child's participation in MPCs VBS program.  WAIVER OF LIABILITY RELATED TO COVID-19:  MPC cannot prevent you or your children from potentially being exposed to, contracting, or spreading COVID-19 while utilizing MPCs services or premises.  Therefore, if you choose to utilize MPCs services and/or enter onto MPCs premises you may be exposing yourself to and/or increasing your risk of contracting, or spreading COVID-19.   I hereby release and waive my right to bring suit against MPC in connection with exposure, infection, and/or spread of COVID-19 related to utilizing MPCs services and premises.  This waiver means I give up my right to bring any claim including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claims I may have to seek damages, whether known or unknown, foreseen or unforeseen.  BY CHECKING THE BELOW BOX THE PARENT/GUARDIAN NOTED ABOVE ACKNOWLEDGES THAT HE/SHE HAS READ, UNDERSTANDS, AND AGREES TO THE TERMS OF THE LIABILITY AND RELEASE STATEMENTS. *
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