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VBS Adventure Camp

VBS Adventure Camp for 2018 was a success. Thank you so very much for sharing your children with us. We are so glad that we were able to share God's love with them.

CHILD/CHILDREN INFORMATION & REGISTRATION FOR LAKELAND REFORMED VBS

*All requested information MUST be provided

June 25-28, 2018

Please pre-register by noon on Monday, June 25

Name of child (first and last name)

Grade entering (Fall 2018)

K 1 2 3 4 5 6

Medical Concern(s)

Parents’/Legal Guardian’s name (first and last)

Mother’s Cell Phone

Father’s Cell Phone

Email address

Street Address

City

State

Zip

Emergency Contact: Emergency Contact: List in order of preference individuals (other than parent/guardian) to be contacted in an emergency

Name of emergency Contact (first and last name)

Phone

Name of emergency Contact (first and last name)

Phone

Release of child(ren): Release of child(ren): List in order of preference individuals (other than parent/guardian) to whom child(ren) may be released

Name of emergency Contact (first and last name)

Phone

Name of emergency Contact (first and last name)

Phone

How did you hear about VBS?

Home church (if you have one)

I understand that photos may be taken of my child for our web page to promote LRC activities.

Yes

By checking this box I acknowledge I am this child's parent or legal guardian and this counts as my signature.

Yes

Email a copy of this message to your own address

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