Vacation Bible School 2021 - June 7-11th

Please fill out this registration form and click submit.

Child's Name (please complete one form for each child attending from your household, Ages K-6th Grade)

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Gender

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Please select one option.

Male Female

Birthdate

*

Grade Completed

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Address

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Parents/Guardian

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Home Phone

Work Phone

Cell Phone

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Email

*

This address will receive a confirmation email

Emergency Contact & Relationship to Child

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Emergency Contact Phone

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Name of Home Church

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Food Allergies

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Please select one option.

Yes No

If yes, list food allergies:

Medical Concerns

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Please select one option.

Yes No

If yes, list medical concerns:

I give permission for my child's image to be used in any ECC publication promotional materials or slide shows, including the ECC website. (By clicking yes, you are providing your electronic signature).

*

Please select all that apply.

Yes No

My child has a current liability waiver form already on file with ECC. (If no or you are unsure, please contact the church office.)

*

Please select one option.

Yes No I'm not sure.

Description

Please fill out this registration form and click submit.

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