Use this on-line registration form to register your child/children for Vacation Bible School 2008. Fill out the form fields completely, and hit the submit button at the bottom of the page. Your information will automatically emailed to the church office. Please complete one form per child. (To register multiple children, you will need to complete the form multiple times)

Please Note:  There is only 1 week of VBS for all age children.

        July 14th - July 18th from 9:30 AM to Noon

        Cost $15 for the first child in the family and $10 for each additional child.

        VBS is open to children who are 3 years old through 6th grade.

(Three years olds must be 3 by September 1, 2007 and have attended a preschool program)

  

Child's Name
Date of Birth
Grade Completed
Street Address
City, State, Zip Code
Parents Names
Home Phone Number
Cell Phone Number
Work Phone Number
Known Allergies
Other Medical Conditions
Child's Physician
Physician's Phone Number
Insurance Company
Insurance ID Number
Alt. Emergency Contact
Alt. Contact Phone Number
I authorize CCUPC and it's employees to obtain medical treatment and transport my child, to Hospital in case of an emergency for my child in the event I cannot be reached or am delayed. You will be required to sign and date this form on the first day of VBS.    Yes, I can help.    No, I cannot help.