VBS 2024 Registration - "Set Sail"
We can't wait to see you at this year's VBS!!
Parent/Guardian 1 Information
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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AA
AB
AE
AK
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AP
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AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Parent/Guardian 2 Information
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Child Information
List the names and grade levels of attendees. Note: Grade entering in the '24-'25 school year
*
Does any child listed above have allergies we should be aware of (food, medications, etc.)? If yes, please specify.
*
Please disclose any care needs your child(ren) may have. It is our goal to provide a safe, fun, and engaging experience for all.
*
Emergency Contact (other than parent/guardian)
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Check-Out Permissions
List individuals permitted to check-out the attendee(s) listed above. Note: NO individual missing from this list will be permitted to retrieve a child from the premises.
*
Waivers and Releases
I hereby consent for my child to receive medical treatment deemed necessary if my child is injured or requires medical attention during his or her participation in this event. I understand and agree that I am solely responsible for all costs related to such medical treatment and any related medical transportation and/or evacuation. I hereby release, forever discharge, and hold harmless Pandora Missionary Church from any claim based on such treatment or other medical services.
*
Please select all that apply.
Agree
I give permission to Pandora Missionary Church staff and volunteers to photograph/video my child during activities and understand that these photos/videos may be used for the promotion of Pandora Missionary Church.
*
Please select one option.
Agree
By my signature below I acknowledge and accept the above "waivers and releases" and attest that all information provided is accurate to the best of my understanding.
Signature
*
Date
*
Submit
Description
We can't wait to see you at this year's VBS!!
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