AMPED VBS REGISTRATION

Thank you for choosing to pre-register your child for Champion Christian Center's 2018 VBS! Please complete the form below to complete your registration. This information will be used to properly place your child into a small group, inform our staff about any allergies or special needs, and provide us with your emergency contact information. As we get closer to the event, keep an eye out for emails from our Champion Staff! These emails will give you more information and communicate important details about this event.

Name

First Name

Last Name

Email Address

Parent/Guardian Phone Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child's Name

Birthday

MM

DD

YYYY

Child's Name

Birthday

MM

DD

YYYY

Child's Name

Birthday

MM

DD

YYYY

Does any child listed above have any allergies or other needs that require special considerations? If yes, please describe below

Is there anyone besides the parent/guardial listed above that will have permission to pick up your child?

Additional Pick-Up Person's Name

First Name

Last Name

Additional Pick-Up Person's Phone Number

(###)

###

####

AMPED VBS REGISTRATION

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