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Home
About Us
Youth
Kids
Grow
Mission
Media
Contact
Vacation Bible School 2018
For ages pre-k through grade 6
Monday June 11th - Friday June 15th
9:00-11:30 am
Video Recap of VBS 2016
VBSRecapFinal
from
Coudersport Alliance Church
on
Vimeo
.
Register Today!
Name of Child
*
Date of Birth
*
Grade Completed
*
Age
*
Name of Child
*
Date of Birth (mm/dd/yy)
*
Grade Completed
*
Age
*
Name of Child
*
Date of Birth (mm/dd/yy)
*
Grade Completed
*
Age
*
Name of Child
*
Date of Birth (mm/dd/yy)
*
Grade Completed
*
Age
*
Parent or Guardian Name
*
First
Last
Address
*
Home Phone
*
Cell Phone
*
Email
*
Emergency Contact Name & Number
*
Special Needs / Allergies / Other Concerns
*
Home Church (If you attend a local church)
*
I further acknowledge that any child registered on this form, as a participant in Vacation Bible School at Coudersport Alliance Church, may be photographed or captured on video during the Vacation Bible School program and activities. I hereby grant full permission to Coudersport Alliance Church to use photographs or videos in print, electronic, online, or other public media of the child registered on this form and further release Coudersport Alliance Church from any and all liability connected with the authorized use of words and image of the child registered on this form.
I have read and agree to the above Liability Release and Photography/Video Authorization
*
Yes
No
Electronic Signature
*
Typing your name here is an electronic signature for Coudersport Alliance Church VBS registration
Submit
✕
