2023 VBS Kids Registration Form

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PVCCC 2023 VBS: The theme is Keepers of the Kingdom!
Date and time: Aug 7-11, 9:00am-3:00pm
Location: PVCCC
Suggested Donation: $80 first kid, $40 every kid after that
Register by July 25th

Email *

Child's Name *

Child's date of birth *

YYYY

Any allergies or medical needs? *

Full Address *

Emergency Contact #1 Name *

Emergency Contact #1 Relation to Child *

Mother

Father

Other:

Emergency Contact #1 Phone Number *

Emergency Contact #2 Name *

Emergency Contact #2 Relation to Child *

Mother

Father

Other:

Emergency Contact #2 Phone Number *

I understand the contagious risks of Coronavirus/COVID-19 and voluntarily assume the risk that my child and/or my family may be exposed to or infected by attending VBS and that such exposure or infection may result in personal injury, illness, permanent disability, or death. *

Yes

Required

I will not hold Peace Valley Chinese Christian Church accountable for any loss or damages during Vacation Bible School *

Yes

Required

I give Peace Valley Chinese Christian Church permission to photograph or video my child during VBS for any lawful purpose including publication, promotion, illustration, advertising, or historical archive in any manner or in any medium. I waive my right, my child’s rights, and my family’s rights to any and all compensation stemming from the use of these materials. *

Yes

Required

Signature (Please print full name) *

Submit

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