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Mail or bring in this registration form with payment to: Ridgefield-Crystal Lake Presbyterian Church 8505 Church Street, Crystal Lake, IL 60012 Office: 815-459-1132 (located behind McHenry County College in Ridgefield) |
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REGISTRATION FORM for VBS 2008 (Vacation Bible School is for children ages 3* through 5th grade) *child must be toilet trained Please list grade child will be entering in the fall. (Current 5th graders are more than welcome to attend.) If not yet in elementary school, please just list the child’s age. Youth T-shirt Name: _____________________________ Grade: ____ Age: ____ size: S M L XL Name: _____________________________ Grade: ____ Age: ____ size: S M L XL Name: _____________________________ Grade: ____ Age: ____ size: S M L XL Name: _____________________________ Grade: ____ Age: ____ size: S M L XL Parent/Guardian: ___________________________ Email: ____________________ Home Phone (___)____________________ Cell Phone (___)_________________ Address: ___________________________________________________________ __________________________________________________________ Please list name of an Emergency Contact and Phone Number (other than the person listed above): Emergency Contact: ____________________________Phone: (___)____________ The bearer of this letter has my permission as parent or legal guardian to act on my behalf in any emergency dealing with the health and welfare of my child and to obtain emergency treatment for them by a licensed physician. o No o Yes Parent/Guardian Signature: _____________________________ Physician’s Name: _____________________________ Phone: (___)___________ Please list special health considerations (e.g. asthma, seizures, food allergies, etc.): Name: _______________ List: _________________________________________ Name: _______________ List: _________________________________________ Name: _______________ List: _________________________________________ Name: _______________ List: _________________________________________ (continued on other side) Ü |