Deep River Church of Christ

VBS Registration

Please complete all fields.  If you have any questions, please feel free to email us at
Child's Name Child's Birthdate
Parent's Email Address
Mother Name Mother Telephone
Father Name Father Telephone
In Case of Emergency Contact: Emergency Telephone
Mailing Address
City, Street, Zip
Home Church
Last Grade Completed
Allergies or other medical conditions:
Your Questions or Comments
"I/we, the parent or legal guardian of this , hereby grant my permission for him/her to participate fully in Vacation Bible School, and hereby give my permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills. Further more, I/we release Deep River Church of Christ from any and all responsibility in connection therewith."
Please type your name in the space to the right to represent your electronic  signature.