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VBS 2019 Registration Form
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* Indicates required question
Email
*
Your email
First name of child (one response per child please)
*
Please enter child's first name
Your answer
Last name of child
*
Please enter child's last name
Your answer
Child's preferred first name
Please enter your child's preferred first name if different than above
Your answer
Going to grade
*
Which school grade will your child will be attending in September?
4
5
Pre-school
3
2
K
6
1
Age
*
What is your child's age?
3
4
5
6
7
8
9
10
11
12
Street address
Please enter your street address. Required only for youngest child entered.
Your answer
City
Please enter your city. Required only for youngest child entered.
Your answer
Postal Code
*
Please enter your postal code. Required only for youngest child entered.
Your answer
Care Card number
*
Please provide your child's BC Care Card number.
Your answer
Parent/Caregiver name
*
Specify the name of the parent/caregiver of the child(ren) listed above.
Your answer
Parent/caregiver home number
*
Your answer
Parent/Caregiver cell phone number
Specify the cell phone number at which the parent/caregiver can be reached (if different from home).
Your answer
Emergency contact name(If possible list someone other then the Parent/caregiver already named).
*
Specify the name of the person who should be contacted in case of emergency.
Your answer
Emergency contact number
*
Specify the phone number at which the emergency contact can be reached.
Your answer
Relationship of emergency contact to you
*
Specify how you know the emergency contact.
Your answer
Allergies/Dietary restrictions
Does your child have any allergies or dietary restrictions? Please list.
Your answer
Notes
Anything else we need to know?
Your answer
How did you hear about us?
*
To help direct future advertising efforts, we would appreciate knowing how you heard about us.
Attending Langley Canadian Reformed Church
Previously attended VBS
Facebook
Received a flyer
Recieved a postcard in the mail
Sign on the road
Other:
Do you have a Bible at home?
Yes
No
Clear selection
Name of home Church, if any?
If you regularly attend a Church, please let us know which one.
Your answer
May we use pictures of your child(ren) for informational or promotional purposes?
*
Yes, I give consent
No, I do not give consent
A copy of your responses will be emailed to the address you provided.
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