VBS Registration

Please complete all fields. If you have any questions, please feel free to email us at vbs@deepriverchurchofchrist.org

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.