VBS Registration Form

SeaQuest Vacation Bible School (VBS) at TKC!

Age 3 to Rising 5th Grade

DATES: July 19-23, 2010

TIMES: 9:30 a.m. - 12.:30 p.m.

LOCATION: The King's Chapel (TKC), 12925 Braddock Road, Clifton, VA 20124

DIRECTIONS FOR COMPLETING THE FORM

Use your TAB button to get from field to field. Please delete any directions or sample text in each field before completing it. Please submit one form for each child you want to register.

PLEASE NOTE: You must click the Submit Button at the bottom of this form for your registration to be complete. If you do not click Submit, we will not receive your registration, and you may lose your space(s) in TKC's Vacation Bible School (VBS)!

Name:

Date of Birth: Last Grade Completed: Age:*

*For Parents of Children Age 3 or 4: To accommodate all the needs of this age group, we ask that you volunteer 1 day of VBS. Child care will be available for siblings under three on the day you volunteer. If it is impossible for you to volunteer, we ask that you pay an "opt-out" fee of $25 (in addition to the registration donation of $10), so we may hire the required staff. Volunteer positions will be assigned as needed and may not be for your child's class.

Parent Name:

Address:

Best Phone: Alternate Phone:

E-mail:

Emergency Contact Name:

Emergency Contact Phone: Relationship to Child:

Special Needs/Allergies:

Is there a friend your child would like to be with in the same age group? Yes No

Name of your child's friend:

Volunteering

Parent volunteer for 3's and 4's (Please check all dates you can volunteer.)

July 19 July 20 July 21 July 22 July 23

I wish to pay the Opt-Out Fee of $25: Yes No

Nursery

Need nursery for child(ren) infant to age 2? Yes No

If yes, number of nursery-aged children: 1 2 3 4 5 6 More than 6

Comments/Suggestions (Please let tell us about your experience with this form of registration and/or how we can improve the form):

Suggested Donation is $10 (to help us with expenses)

Opt-out fee and donation may be paid on July 19, 2010.

Submit Registration Form to The King's Chapel

PLEASE NOTE: You must click the Submit Button above for your registration to be complete. If you do not click Submit, we will not receive your registration, and you may lose your space(s) in TKC's Vacation Bible School (VBS)! Please do not click Submit more than once! We will send you a Confirmation e-mail to let you know that your child or children are registered for VBS at The King's Chapel.

Reset Registration Form to Register Someone New (Please note that this will reset ALL your information.):