PARENT/CAREGIVER INFORMATION

First Name *

Last Name *

Address *

City *

State *

AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY PR VI Other

Zip *

Cell Phone Number *

Email *

Home church *

Child(ren) resides with *

Both parents

Father

Mother

Other (please explain below)

If other, please explain housing situation and relationships.

CHILD INFORMATION (1)

First Name (1) *

Last Name (1) *

Birthdate (1) xx-xx-xxxx *

Gender (1) *

Male

Female

Food or Other Allergies/special considerations including a need for sensory adaptations (1)

Grade Completed (1) *

Pre-Preschool (2-3 yrs)

Preschool (3-5 yrs)

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

If you selected Preschool for grade completed, please list Preschool attended. (1)

T-shirt sizes will not be guaranteed for registrations after May 15.

Crews will be mixed ages in these categories: Pre-Preschool, Preschool, Kindergarten-Grade 2, Grade 3-5.

Every effort will be made to honor friend requests. If friends cannot be in the same crew, they will be in the same rotation.

VBS t-shirt size (1) *

Child XS

Child S (6-8)

Child M (10-12)

Child L (14-16)

Adult S

Adult M

Adult L

VBS friend/leader request (1)

CHILD INFORMATION (2)

First Name (2)

Last Name (2)

Birthdate (2) xx-xx-xxxx

Gender (2)

Food or Other Allergies/special considerations including a need for sensory adaptations (2)

Grade Completed (2)

Pre-Preschool (2-3 yrs)

Preschool (3-5 yrs)

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

If you selected Preschool for grade completed, please list Preschool attended. (2)

VBS t-shirt size (2)

Child XS

Child S (6-8)

Child M (10-12)

Child L (14-16)

Adult S

Adult M

Adult L

VBS friend/leader request (2)

CHILD INFORMATION (3)

First Name (3)

Last Name (3)

Birthdate (3) xx-xx-xxxx

Gender (3)

Male

Female

Food or Other Allergies/special considerations including a need for sensory adaptations (3)

Grade Completed (3)

Pre-Preschool (2-3 yrs)

Preschool (3-5 yrs)

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

If you selected Preschool for grade completed, please list Preschool attended. (3)

VBS t-shirt size (3)

Child XS

Child S (6-8)

Child M (10-12)

Child L (14-16)

Adult S

Adult M

Adult L

VBS friend/leader request (3)

CHILD INFORMATION (4)

First Name (4)

Last Name (4)

Birthdate (4) xx-xx-xxxx

Gender (4)

Male

Female

Food or Other Allergies/special considerations including a need for sensory adaptations (4)

Grade Completed (4)

Pre-Preschool (2-3 yrs)

Preschool (3-5 yrs)

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

If you selected Preschool for grade completed, please list Preschool attended. (4)

VBS t-shirt size (4)

Child XS

Child S (6-8)

Child M (10-12)

Child L (14-16)

Adult S

Adult M

Adult L

VBS friend/leader request (4)

If you have more than 4 children to register please complete this form and email Dawn (dridgway@popmn.org) with additional child's information.

EMERGENCY CONTACT - if parent(s) cannot be reached

First & Last Name

Relationship to family (grandparent, neighbor, etc)

Phone Number

Thank you for registering. If you are able to volunteer before/during VBS please fill out the separate VBS Volunteer form.

If you would like to support camper scholarships and additional VBS expenses, please mark your donation on the next page. Thank you for your generosity!

I have read, discussed with my child(ren), and agree to the attached liability and behavior agreement.

Yes

Liability/Permission/Behavior Agreement *

Liability, Permission and Behavior Agreement 2023_24.pdf

I want to be reminded