Circus on the Ark VBS 2019

Child's Name

Only one child per form please

Parent Email

This address will receive a confirmation email

Parent Contact #

Address

Emergency Contact Name (Must have an ID if needed in the case of emergency.)

Emergency Contact #

Any Allergies, Medical or any other matters that we should be informed of for the safety of your child?

For safety and staff reasoning your child must be of school age to particapate in vbs. Please indicate what grade your child will enterin into in the 2019/2020 school year.

KINDERGARTEN 1ST GRADE 2ND GRADE 3RD GRADE 4TH GRADE 5TH GRADE 6TH GRADE 7TH GRADE

I give permission for my child to be photographed. Photos will be used for promotional purposes and may appear on church website, church newsletter, and Facebook page etc.

YES NO

Is there another child that will be attending that your child would like to be paired with if possible? Please indicate other child name.

I understand that Mt Zion Church will not be providing transportation. I understand I am responsible for dropping of my child no earlier than 5:45 pm and picking up my child no later than 8:10pm This is with the exception of Apprecation Celebration Kids Day.

YES

Appreciation Celebration Kids Day will begin at 10:45 am we understand some children already attend a home church. We encourage you to arrive when you can and do not feel obligated to be present during your church service time your welcome to join at any time. The children will particapate in Sunday Service awards and grand prizes will be given during this time any awards will remain available up until 2pm the day of. We are also providing a lunch and fun activites along with the back 2 school giveaway which will take place after the ACK day service (noon). So that we can do our best at accomidating everyone it will help to know approximatly how many will be in your party on ACK day no matter what time you will be arriving. Please indicate how many you plan for. If you have more than one child to be registered on list the number of your party on one childs form and select option Only child for this section please.

1-2 Attending 3-5 Attending More than 5 Only my child will be attending No one is able to attend ACK day.

Electronic Signature: All of the stated information is accurate to the best of my knowledge. I understand that typing my name in the box below represents my electronic signature and consent to all terms and conditions.

Todays Date

Donation to help fund VBS Optional

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Circus on the Ark VBS 2019

Description

Please Fix the Following