2022 Maurice Reformed VBS Student Registration Form

Parent/Guardian Name

Address

This address will receive a confirmation email

Phone

Home Church

Tell us about your kids!
You may register up to four kids per form. If you have more than four, please fill out as many times as needed. If you complete multiple forms, please pay no more than the $50 max per family.
**REGISTER FOR THE GRADE YOUR CHILD WILL GO INTO NEXT FALL ('22 - '23 SCHOOL YEAR).**

Student 1

Student's First Name

Student's Last Name

Gender

Male Female

Age (as of June 3)

Grade This Coming FALL

Medical concerns/allergies/food allergies (you may be contacted at a later date for more information):

Other needs or information we should know about (you may be contacted at a later date for more information):

Student 2

Student's First Name

Student's Last Name

Gender Male Female

Age (as of June 3)

Grade THIS Coming FALL

Medical concerns/allergies/food allergies (you may be contacted at a later date for more information):

Other needs or information we should know about (you may be contacted at a later date for more information):

Student 3

Student's First Name

Student's Last Name

Gender Male Female

Age (as of June 3)

Grade THIS Coming FALL

Medical concerns/allergies/food allergies (you may be contacted at a later date for more information):

Other needs or information we should know about (you may be contacted at a later date for more information):

Student 4

Student's First Name

Student's Last Name

Gender Male Female

Age (as of June 3)

Grade THIS FALL

Medical concerns/allergies/food allergies (you may be contacted at a later date for more information):

Other needs or information we should know about (you may be contacted at a later date for more information):

Payment Information

I/We give permission for first aid treatment or calling of emergency personnel to attend to medical/emergency needs of my child(ren) while at Maurice Reformed Church for VBS.

I/We Agree

I understand that pictures will be taken during VBS week and may be used on MRC's publications and/or social media sites.

I/We Agree

Cost: Please note the cost is $20 per child, with a maximum of $50 per family.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2022 Maurice Reformed VBS Student Registration Form

Description

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