Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
Parent/Guardian Phone
*
(###)
###
####
Address (Street, City, Zip Code)
*
Emergency Contact #1 (Name, Phone Number, & Relationship)
*
Emergency Contact #2 (Name, Phone Number, & Relationship)
*
Who can pick up your child at the end of VBS each day?
*
Child #1 Name
*
You can register additional children below.
First Name
Last Name
Child #1 Age
*
Child #1 Medical Information
Please include food allergies, learning differences, and anything else we should know.
Do you have additional children to register?
*
Yes
No
Would you like to attend lunch after VBS Monday through Wednesday?
*
Yes
No
How did you hear about VBS?
*
Attend Christ Church Chicago
Friend/Family Member
Neighborhood Advertising
Other
Do you attend church? If so, where?
Please leave any additional comments or questions here, and we will email you back!
Medical Release
*
By submitting this registration form, I release Christ Church Chicago, its staff, employees, officers and volunteers from any and all liability in the event of injury, illness, or incident while participating in VBS. I give the staff and volunteers at Christ Church Chicago permission to seek medical treatment for my child in the event of an emergency when I cannot be reached.
Media Release
*
I agree to allow Christ Church Chicago to use videos and photos of my child (without name) in their public media, including the website and social media.
