VBS Registration - Rainforest Falls

Parent Name

This address will receive a confirmation email

Phone

Address

How did you hear about us?

Do you have a church home?

Yes No

Name of home church (if applicable)

Child 1 Information

Name

Birthdate (including year)

Grade entering in the fall

Any food allergies/ medical restrictions we should know about?

Any additional needs or other factors we should be aware of to best support your child?

If your child has a friend/sibling they would like to be grouped with, please list their name here. We will do our best to honor this request but it is not a guarantee.

Child 2 Information

Name

Birthdate (including year)

Grade entering in the fall

Any food allergies/ medical restrictions we should know about?

Any additional needs or other factors we should be aware of to best support your child?

If your child has a friend/sibling they would like to be grouped with, please list their name here. We will do our best to honor this request but it is not a guarantee.

Child 3 Information

Name

Birthdate (including year)

Grade entering in the fall

Any food allergies/ medical restrictions we should know about?

Any additional needs or other factors we should be aware of to best support your child?

If your child has a friend/sibling they would like to be grouped with, please list their name here. We will do our best to honor this request but it is not a guarantee.

Child 4 Information

Name

Birthdate (including year)

Grade entering in the fall

Any food allergies/ medical restrictions we should know about?

Any additional needs or other factors we should be aware of to best support your child?

If your child has a friend/sibling they would like to be grouped with, please list their name here. We will do our best to honor this request but it is not a guarantee.

Emergency Contact

In the case of an emergency and if the parent or guardians listed above cannot be reached in a reasonable period of time, the individuals listed below may be contacted, given notification of the emergency, and be authorized to provide instructions for the actions to be taken.

Contact's Name

Contact's Phone

Relationship to Student

Relative Friend

Release of Liability

I acknowledge and understand there are inherent risks associated with some Countryside Christian Church activities. I will assume the risks associated therewith, whether known or unknown to me at this time. I recognize that my student's attendance at a Countryside Christian Church sponsored event is a privilege and as a consideration for this privilege, I release Countryside Christian Church including it's employees, agents and trustees, from responsibility for my student's accidental physical injury, including death or illness while at a sponsored trip or activity or during travel to and from events. This release is intended to incude all claims made by my family, estate, heirs, personal representatives or assigns.

Parent Initials

Media Consent

I hereby grant permission to Countryside Christian Church the right to take, use, reproduce, and/or distribute photographs, films, video, and sound recordings of my student, without compensation or approval of rights, for use in materials created for the purposes of promoting the activites of Countryside Christian Church.

Parent Initials

First Aid and Emergency Medical Treatment

I recognize that there may be occasions where the student named above may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hearby give permission for agents of Countryside Christian Church to seek and secure any needed medical attention or treatment for the student named above, including hospitalization, if in the agent's opinion such need arises. In doing so, I agree to pay all fees and costs arising from this medical treatment. I also give permission for attending physician(s) and other medical personnel to administer any needed medical treatment and again, I agree to pay for the medical treatment.

Parent Initials

Select Payment Option

Due to limited classroom space, our Pre-K/Kindergarten class has a maximum capacity of 20 students. Once that limit is reached, we will begin a waitlist.

To help manage the waitlist and encourage consistent attendance in this high-support class, a non-refundable $20 registration fee will be required for all Pre-K and Kindergarten enrollments.

Payment - Select the option that reflects your registration

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Sunday July 26th - Thursday July 30th 6:00pm-8:30pm

(Registration for Pre-K/Kindergarten students is $20. Our preschool/kindergarten class is limited to 20 kids and will be on a first-come, first-serve basis)

Please complete this form to join us for VBS at Countryside Christian Church! VBS at Countryside is for kids aged four through incoming 6th graders.
5775 McLeod Ln NE Keizer, Oregon

At Rainforest Falls, kids explore the nature of God—discovering who God is and how much he loves
them! Kids participate in memorable Bible-learning activities, sing catchy songs, play teamwork-building games, make and devour yummy treats, experience one of-a-kind Bible Adventures, collect Bible Memory Buddies, and test out sciency fun experiments they’ll never forget. Plus, kids will learn to look for evidence of God all around them through something called God Sightings.

VBS Registration - Rainforest Falls

Description

Please Fix the Following