VACATION BIBLE SCHOOL June 24-28 5:30pm dinner, 6-8pm Open to ages 5 -12 First Presbyterian Church of Hawley 815 Church Street Hawley, PA 18428 570-226-4835

Please return this registration form to the church office or register online (myvbs.org/fpch)

by Friday, June 21)

Child’s Name: ___________________________ Nick name: ___________	Gender (circle): M / F

Parent/Guardian Name(s): _____________________________________________________________

Address: ___________________________________________________________________________

E-mail Address(es): __________________________________________________________________

Phone Numbers: Home: ___________________Cell: _________________ Work: ________________

PARTICIPANT INFORMATION

Date of birth: _________________ Age: __________Last school grade completed: _________________

Home Church: _______________________________________________________________________

Food Allergies: ______________________________________________________________________

Allergies/Medical Issues/Information/Other: ______________________________________________

____________________________________________________________________________________

DISMISSAL INFORMATION

Name(s) of person(s) who may pick up this child from VBS:

____________________________________________________________________________________

EMERGENCY CONTACTS

Name/Relation: ________________________________________ Phone: _______________________

Name/Relation: ________________________________________ Phone: _______________________

Important information and signature required on reverse

Important information:

Children should have socks and sneakers for games as well as a change of clothes to be stored in their VBS bag.

Waterproof sunscreen should be applied to children before they arrive or supplied and kept in their VBS bag if you would like it to be applied before the games rotation outside.

Please indicate on the registration form if a child would like to be in the same class as a friend.

Medical Release: I give my permission to VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

Photo Release: I hereby grant the First Presbyterian Church of Hawley permission to use photography/videos taken at VBS, of the minor designated above, for any purpose lawful at any time (advertising, displays, program promotion, et cetera). I waive any right that I may have to inspect or approve the finished product or written/posted copy, that may be used in conjunction therewith, or the use to which it may be applied.

I have read and understand the above important information, medical, and photo releases.

________________________________________________	________________________________

Parent/Guardian signature	Date

Note: We will never distribute your contact information to others, though we may use it to contact you in the future with information regarding future events.

If you are interested in volunteering for VBS please contact Nancy at 570-226-5040 or visit our online registration page at www.myvbs.org/fpch . Please note, background clearances will be required for all volunteers.

Brief Survey

How did you hear about First Presbyterian Church VBS this year?

________ Friend/Word of Mouth

________ Facebook

________ Flyer

________ TV

________ Magazine

________ Other