Encanto VBS 2022 Child Registration
Please fill out this form and click submit.
Child's Name
*
Grade that child will be in Fall 2022
*
Please select all that apply.
4-5 Years Old
1st Grade
2nd Grade
3rd Grade
4th Grade
5th-6th Grade
Gender
*
Please select all that apply.
Boy
Girl
Allergies (if none, write NONE)
*
Special Needs (if none, write NONE)
*
Parent's Name
*
Phone
*
Email
*
This address will receive a confirmation email
Address
*
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AS
AZ
BC
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DC
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ID
IL
IN
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KY
LA
MA
MB
MD
ME
MH
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MO
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MT
NB
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ND
NE
NH
NJ
NL
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NS
NT
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PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Other Authorized Pick-up (must be 18+, can list multiple people)
*
Does this child have any special needs or medical conditions that may prevent participation in any activities? Is so, list below. If not. write NONE.
*
I agree to allow pictures or video that may include my child to be a part of event related presentation. I understand all will be in good taste. I agree to hold harmless and indemnify MovementChurch.online, its directors, employees and volunteers from any and all liability as a result of willful, intentional or negligent act of said participants.
Parent Signature
*
Submit
Description
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