Event Registration

Register for our event by filling out the information below:

Child's info:

Child's Name

Child's Gender

Child's Birthdate

Child's Last Grade Completed

Street Address

City

State

Zip Code

Parent's Info

Parent's Name

Home Phone

Work Phone

Cell Phone

Email Address

Emergency Contact Info

Emergency Contact Name

Emergency Contact Relation to Child

Emergency Contact Phone

Additional Information

Authorized Pick-Up People

Name of Home Church, if applicable

Food Allergies

Medical Concerns

Medical Release

I understand that, in the event medical treatment and/or transportation is required, every effort will be made to contact me. However, if I cannot be reached, I give permission to the staff at The Bridge Church to secure services of a licensed physician and/or licensed emergency team to provide necessary care for my child's well-being. The undersigned shall be the aforementioned child pursuant to this authorization.

Parent/Guardian Electronic Signature (for medical release)

Date

Thank you for registering for VBS 2017!