2024 VBS Student Registration

Parent/Guardian Name

This address will receive a confirmation email

Phone

Address

Child's Name

Child's Age

Child's Birthdate

Last school grade completed.

Preschool (ages 3-5) Kindergarten 1 2 3

Allergies/Medical Information/Other

If your child has special needs, please describe them here.

Please feel free to include any information that would help us get to know your child better.

Name and phone number of emergency contact if different than Parent/ Guardian listed above.

Name and phone number of up to two people, other than yourself, who are authorized to pick up your child from VBS.

Will you be attending the Family Party on Friday, June 14? Yes No

If yes, how many will be attending?

Parental Consent I give my permission for my child to participate in Stonybrook Church Children and Family Ministries programming. I understand that photographs and/or video/audio recording made during children's ministry programming may include my child, and I authorize use of such photographs or recordings at the discretion of Stonybrook Church.

Liability Release & Authorization I certify the information provided is correct to the best of my knowledge. In the event of an emergency, I give permission to the directors of the activity and/or Stonybrook Church to render First Aid, as well as permission to a licensed physician to hospitalize, anesthetize, or perform surgery on the person/s listed. I understand that every reasonable effort will be made to make contact with the prior mentioned emergency contact before these actions are taken. I acknowledge that I am responsible for payment of medical charges or expenses not covered by my insurance or the insurance applicable to my child (if any). I further agree to hold harmless and indemnify the Stonybrook Church staff, volunteers and Stonybrook Church from any and all claims for damages arising out of personal injuries sustained by my son/daughter/ward during any activities while at Stonybrook Church or authorized off property events. I hereby fully and forever release and discharge the Stonybrook Church staff, volunteers and Stonybrook Church from any and all said claims.

Description

June 10-14, 2024

We are thrilled you have decided to enroll your child in our swimmingly spectacular VBS! Registration is open to children ages 3-11. VBS will be both indoors and outdoors, enjoying the beauty of our Stonybrook property. Should there be inclement weather, we have indoor space reserved. Please dress your child in closed-toed shoes and play clothes.

If you have multiple children, please register each child separately.

You will receive a confirmation email upon submission of this form. Please contact Kasey Fathauer-Lynch with any questions 614-471-0252, ext. 111.

2024 VBS Student Registration

Description

Please Fix the Following