VBS 2017


    Participant's Name (required)

    Date of Birth (mm/dd/yyyy - required)

    Child's Age (required)

    Address (required)

    Parent/Guardian Name (required)

    Parent/Guardian Email (required)

    Grade Completed (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


    Participant's Health Card # (required)

    Who will be picking your child up? (required)

    Physician's Name & Number (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

    T-shirt size (required)

    XS (4-5)S (6-7)M (8-9)L (10-11)XL (12-14)Adult S

    I would like to be a part of the church mailing list and receive church updates and newsletters.



    I hereby give my permission for my child to participate in Westminster’s Vacation Bible School.

    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 School activities. I acknowledge that typing my name represents my digital signature and agreement to submit payment.

    Parent/Guardian Name (required)

    Date (mm/dd/yyyy - required)