If you would like to register for VBS, please complete the form below.
How many children are you registering for?
*
How many children are you registering for? *
One
Two
Three
Four
1st Child's Information
Name
*
First
Last
Date of Birth
*
MM slash DD slash YYYY
School Grade
*
2nd Child's Information
Name
*
First
Last
Date of Birth
*
MM slash DD slash YYYY
School Grade
*
3rd Child's Information
Name
*
First
Last
Date of Birth
*
MM slash DD slash YYYY
School Grade
*
4th Child's Information
Name
*
First
Last
Date of Birth
*
MM slash DD slash YYYY
School Grade
*
Parent Information
Name
*
Phone Number
*
Email
*
Address
*
Street Address
Address Line 2
City
State
State *
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Emergency Contact Name
*
Emergency Contact Phone Number
*
Are you a member of the River?
*
Are you a member of the River? *
Yes
No
How did you hear about Vacation Bible School?
*
How did you hear about Vacation Bible School? Please tell us below! *
Medical Release
*
Medical Release: If at any time medical or first aid treatment is required due to circumstances such as accident, sudden illness or emergency, I/We authorize that this treatment may be given, including necessary anesthetic, by a private physician or hospital. I/We also consent emergency transportation if necessary. *
I do
I do not
Waiver of Claims
*
Waiver of Claims: I/We permit the child stated above to take part in Vacation Bible School—to be held at River of Life Fellowship Church (ROLF), and agree to waive any claims upon ROLF (or any of it's Agents) in the event of injury, loss, or damage, (however caused), that may be sustained by the above-mentioned child, while taking part in the programs, and in all matters relating to the ministries organized by ROLF. I/We understand the risks involved in the nature of these programs. *
I agree
I disagree
Photography/Videotaping Release
*
Photography/Videotaping Release: I hereby give consent for my child to be photographed or videotaped for promotional use by River of Life Fellowship Church. They will not be forwarded to any third party. *
I do
I do not