Church of the Nativity | Vacation Bible School

Vacation Bible School Online Registration Form. You may register for Vacation Bible School online using this form. The cost is $25.00 for one child or $40.00 for two (2) or more children. Payment can be made with either a credit card or Paypal account. Upon completing this form you will be taken to the Paypal website for payment processing. Alternatively, if you rather not pay online and would prefer to pay by check or cash, you can simply visit us at the Church's front desk and register there.
Fathers First and Last Name:
Mothers First and Last Name:
Email:
Phone:
Fax:
Address 1:
Address 2:
City:
State:
Zip:
How many children will you be signing up today?
Child's Name: Child's Social Security Number: - - Child's Date of Birth: / / Male/Female: Male Female How old is your child: Child T-Shirt Size:: If this child is aged 6-10, please select a meeting time: 9:00am 4:00pm
Child's Name: Child's Social Security Number: - - Child's Date of Birth: / / Male/Female: Male Female How old is your child: Child T-Shirt Size:: If this child is aged 6-10, please select a meeting time: 9:00am 4:00pm
Child's Name: Child's Social Security Number: - - Child's Date of Birth: / / Male/Female: Male Female How old is your child: Child T-Shirt Size:: If this child is aged 6-10, please select a meeting time: 9:00am 4:00pm
Child's Name: Child's Social Security Number: - - Child's Date of Birth: / / Male/Female: Male Female How old is your child: Child T-Shirt Size:: If this child is aged 6-10, please select a meeting time: 9:00am 4:00pm
Child's Name: Child's Social Security Number: - - Child's Date of Birth: / / Male/Female: Male Female How old is your child: Child T-Shirt Size:: If this child is aged 6-10, please select a meeting time: 9:00am 4:00pm

I am covered by hospitalization and medical insurance. My policy number is: My policy is issued by: . I do not have medical coverage and assume responsibility for the cost of hospitalization and medical care for my son/daughter. ADD any other medical information concerning medication, allergies, illness, etc. ADD any dietary restrictions: Parents/guardians of participants are advised that photographs or videotape of participants may be used in publications, websites or other materials produced from time to time by the Church of the Nativity. (Participants would not be identified, however, without specific written consent.) Parents/guardians who do not wish their child(ren) to be photographed or filmed should so notify the Church in writing.
Additional comments (such as requests for a teacher): *Your information will be transmitted securely.