Vacation Bible School

The Theme this year is: “Scuba, diving into a friendship with God.”

Children will be on a thrilling underwater journey, where they can dive into the unceasing, boundless love of God.

Sunday, July 28—Thursday, August 1 from 6:00—8:30PM

For all children ages 4yr to entering 5th grade

Note that you must be registered by July 7 to be guaranteed a VBS themed t-shirt.

Vacation Bible School

Parents Information

Parents Name*

Address*

Phone*( ) -

Email*

Home Church

Childs Information

1st Child*

Grade entering in the fall*

Child Date of Birth*

T-Shirt Size*

Small (6-8) Medium (10-12) Large (14-16) Adult Small Adult Medium

Friend's Name

List any allergies

Additional Children

2nd Child

Grade entering in the fall

Child Date of Birth

T-Shirt Size

Small (6-8) Medium (10-12) Large (14-16) Adult Small Adult Medium

Friend's Name

List any allergies

3rd Child (To register more children submit this form and do it all again)

Grade entering in the fall

Child Date of Birth

T-Shirt Size

Small (6-8) Medium (10-12) Large (14-16) Adult Small Adult Medium

Friend's Name

List any allergies

Emergency Contact

Emergency Contact Information*

Phone*( ) -

Any additional comment?

RELEASE*

I Accept

I hereby consent that my child, under the supervision of the VBS staff of Palos Heights CRC, may: 1) Have his/her name, picture, portrait, or photograph used in all forms and media and in all manners, including composite representations, for advertising, trade, or any other lawful purposes, and I waive any right to inspect or approve the finished version(s), including written copy that may be created and appear in connection therewith. 2) Receive emergency medical treatment at a local medical facility as necessary in the event parent, guardian, or emergency contact cannot be reached to arrange for such treatment.

Please leave this field blank.