Please leave this field empty.
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If you have more than one child to register - you will need to complete a form for each child. Thanks!
Participant Name (required)
Date of Birth (mm/dd/yyyy - required)
Child's Age (required)
T-shirt Size (required) xs(4)s(5-6)m(7-8)l(10)xl(12)adult small
Grade Currently In (required)
—Please choose an option—JKK1234567+
Participant's Health Card # (required)
Parent/Guardian Name (required)
Parent/Guardian Email (required)
Address (required)
Postal Code (required)
Home Phone
Work Phone
Cell Phone
Best number during camp hours
Emergency Contact Name (required)
Emergency Phone (required)
Emergency Contact Name (other than parent)
Emergency Phone
Physician's Name & Number (required)
Who will be picking your child(ren) up? (required)
Home Church (if applicable)
Medical or special needs information we need to know (please include any food allergies, school support needed i.e. E.A., fine motor accommodations etc.).
Names of friends/relatives you would like to be in a group with
I would like to be a part of the church's weekly e-mailing list and receive church updates
YesNo
I grant permission for my child to be photographed for use on the church’s social media (Facebook, Instagram) accounts while participating in Vacation Bible School activities.
I hereby give my permission for my child to participate in Westminster’s Vacation Bible Camp.
I understand all reasonable precautions for health and safety of the participant will be taken during camp. S/he will be properly supervised during all activities. In the event of an accident or illness Westminster Presbyterian Church, its staff and volunteers are released from any liability.
In the event of injury requiring medical attention, I authorize treatment for the participant and understand that reasonable attempts will be made to contact me should such a situation occur.
I grant permission for my child to be photographed (for church purposes only) while participating in Vacation Bible Camp activities. I acknowledge that typing my name represents my digital signature and agreement to submit payment.
Date (mm/dd/yyyy - required)