CCUCC VBS Student Registration 2022

Date

Mother's Full Name

Mother's Preferred Phone

Father's Full Name

Father's Preferred Phone

Preferred Email

This address will receive a confirmation email

#1 Student Full Name

#1 Student Birthday

#1 Student Grade Level in Fall of 2022

#1 Student School Name

#1 Student T Shirt SIze

Youth XS Youth S Youth M Youth L Youth XL Adult S Adult M Adult L

#2 Student Full Name

#2 Student Birthday

#2 Student Grade Level in Fall of 2022

#2 Student School Name

#2 Student T Shirt Size Youth XS Youth S Youth M Youth L Youth XL Adult S Adult M Adult L

#3 Student Full Name

#3 Student Birthday

#3 Student Grade Level in Fall of 2022

#3 Student School Name

#3 Student T Shirt Size Youth XS Youth S Youth M Youth L Youth XL Adult S Adult M Adult L

Is there anyone, besides parents, who are permitted to pick up your student(s) from VBS?

Are their any allergies/medical concerns CCUCC should be aware of? Please indicate child's name and nature of concern. If none, indicate by answering N/A.

May we post picture(s) of your students in the church or newsletter?

Yes No

May we post pictures of your student(s) on social media or the church's website?

Yes No

Is there anything else the teachers should be aware of?

I agree that CCUCC, staff and volunteers are not responsible for accidental injuries that occur during my student(s) time at VBS. I authorize such medical treatment as is necessary and such additional procedures as are considered necessary during the course of a medical examination.

I Agree

One Student ($15.00)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

June 27th thru July 1st

CCUCC Vacation Bible School will be held Monday, June 27th thru Friday, July 1st from 9am-11:30am. The last day to register is June 1st (or when 50 students have registered; whichever comes first). The cost of each student will be $15 and includes a t-shirt. Grants are available for VBS tuition if needed. Please contact Shelly at office@theccucc.org for additional information.

VBS is for ages 3 years (for members of CCUCC) or 5 years (for non-members) thru 6th Grade. If your student(s) is entering 7th grade and up, they are welcome to assist with VBS by registering as a Helper. Please use the "Volunteer Form" to register their information.

CCUCC VBS Student Registration 2022

Description

Please Fix the Following