Participant Registration

2024 Vacation Bible School - Breaker Rock Beach (For kids entering K-5th grades in Fall of 2024.)

    
1Complete Form

Option:  

Required  Price: 
Description: 
 = Required Field

 Participant Information

 
 
 
 
  Select Month/Day/Year
 
 Grade ('24-'25): 
 Emergency Contact 
 Emergency # 
 Church  (if you regularly attend church which one?) 
 Carpool Link  You may list 1 child that is entering the same grade as your child to be placed together. 3-5th gr. groups are gender specific. 
 Snack/Food Allergy Information   
 Authorized Pick Up Person #1 Required
 Authorized Pick Up Person #2 Required
 Authorized Pick Up Person #3 
 Health Issues /Special needs that we need to know: 
 Opt out of all photos including class picture 


 Photo Release

CONSENT TO PHOTO RELEASE 

I grant permission for video(s) or photo(s) of my child/children to appear among other general photos/videos as long as there is no identifying information shown.

 CONTACT INFORMATION

GUARDIAN #1

 
 STATE 
 ZIPCODE 
 1 of the 3 phone numbers below must be filled in
 HOME 
 WORK 
 CELL 
 PREFERENCE 
GUARDIAN #2 (optional)

 
 STATE 
 ZIPCODE 
 1 of the 3 phone numbers below must be filled in
 HOME 
 WORK 
 CELL 
 PREFERENCE 

 Refund Policy

 Contact Info