VBS Registration Form

Child's Name(*)
Please let us know your name.

Age(*)
Invalid Input

Street Address(*)
Invalid Input

Postal Code(*)
Invalid Input

Email Address(*)
Please let us know your email address.

Emergency Contact(*)
Please write a subject for your message.

Phone #(*)
Invalid Input

Relationship(*)
Invalid Input

2nd Emergency Contact(*)
Invalid Input

Phone #(*)
Invalid Input

Relationship(*)
Invalid Input

Health Card #(*)
Invalid Input

Allergies or other concerns(*)
Invalid Input

Who will be picking up your child/children each day?(*)
Invalid Input

May we take photographs of your child and use them in our photo gallery?(*)
Invalid Input

Choose Program(*)
Invalid Input

How did you hear about this program?(*)
Invalid Input

T-Shirt size(*)
Invalid Input

Liability Release(*)
Please agree to our liability terms to submit this form.

This agreement releases Covenant Christian Reformed Church from all liability relating to injuries or harm that may occur while participating in the VBS program. By checking YES to this agreement, I agree to hold Covenant Christian Reformed Church entirely free from any liability, including financial responsibility for injuries or harm incurred, regardless of whether injuries are caused by negligence. I also acknowledge the risks involved in the activities. Additionally, I do not have any conditions that will increase my likelihood of experiencing injuries or harm while engaging in this activity. By checking yes, I forfeit all right to bring a suit against Covenant Christian Reformed Church for any reason. I will also make every effort to obey safety precautions as explained to me verbally. I will ask for clarification when needed. Covenant Christian Reformed Church cannot guarantee that food products or snacks have not been in contact with peanuts or peanut by-products.