Breaker Rock Beach VBS 2024

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Attendee Information

First Name *

Preferred Name

Last Name *

Date of Birth *

Gender *

School Grade for year 2024-2025 *

Getting to know your child:

Special Needs Child

Developmental Delay

If you answered yes to either of the last two questions please specify:

Allergies:

Other Allergy:

Parent/Guardian Information

Parent/Guardian Name *

Tip: First and Last

Relation to the Attendee *

Phone Number *

Email Address *

Home Address *

Home Address Line 2

Home City *

Home State *

Home Zip Code *

Please list anyone other than main parent/guardian that is able to pick up your child with proper ID: *

As the parent or legal guardian of the above-mentioned child, I understand that unless I am a registered and verified VBS volunteer for Springview Community Church, there is a dedicated parent area for me to wait in and I will not be able to walk around to secured areas.

Please type your full name to confirm. *

Tip: We strive to keep your children and our church as safe as possible, and part of that is limiting interaction to only background checked individuals after check in.

During Vacation Bible School, we will be taking pictures and video of the children during activities. Your child will be in some of the photos / videos. During Vacation Bible School, pictures will be posted on our public Instagram and Facebook page to show our parishioners and community how much fun the children are having at VBS. The pictures and video will be used for these purposes ONLY.

Photo Consent *