online registration form - First Presbyterian Church of LaGrange

Vacation Bible School
Mon., July 27– Thu July 30, 2015
9a.m.–12p.m.
Friday, July 31, 2015
9am—12pm & *6—8pm
*NEW Family VBS Review & Dinner
Age 4 to Incoming Grade 5
*Early Discount—$30/child (sugg’d donation); $80/max.family
*After July 10—$40/child & $90/max. family
Financial assistance available
First Presbyterian Church 150 S. Ashland Ave., La Grange
www.fpclg.org / 708.354.0771 / admin@fpclg.org
Please fill out both sides of the registration form (one form per family)
and submit to the Church Office with check payable to FPCLG.
Hurry! Registration closes when classes are full—class size is limited.
Volunteers (Grade 6-Adult) please complete reverse side of the form.
Parent/Adult Information:
Name(s): ______________________________________________________
Address: ______________________________________________________
1. Child’s Name: _____________________________________________
Grade – Fall ‘15:_____ Birth Date (Must be 4 by July 27): _________
Food allergies or other medical concerns?
No
Yes (describe)
_________________________________________________________
2. Child’s Name: _____________________________________________
Grade – Fall ‘15:_____ Birth Date (Must be 4 by July 27): _________
Food allergies or other medical concerns?
No
Yes (describe)
_________________________________________________________
3. Child’s Name: _____________________________________________
Grade – Fall ‘15:_____ Birth Date (Must be 4 by July 27): _________
Food allergies or other medical concerns?
No
Yes (describe)
_________________________________________________________
4. Child’s Name: _____________________________________________
Grade – Fall ‘15:_____ Birth Date (Must be 4 by July 27): _________
Food allergies or other medical concerns?
No
Yes (describe)
_________________________________________________________
City: ________________________________________ State: ___________
Emergency Information: Please list emergency information for your
child(ren) in the event that you are not available.
Home Phone: __________________ Alt. Phone: __________________ ____
Emergency Contact Person: _____________________________________
E-Mail Address: _________________________________________________
Home Phone: _____________________ Alt. Phone: _________________
Member of FPCLG:
Yes
No church affiliation
No/Belong to (Church): _________________________________________
Please list names of other people who might be picking your child up at the
end of the day (babysitter, neighbor, friend, etc.):
______________________________________________________________
In the event of an emergency, I give my permission for the Vacation Bible
School volunteers to seek medical treatment for my child(ren). I further give
permission to doctors and hospital staff to provide medical/surgical treatment necessary for my daughter/son. I understand I will be contacted as
quickly as possible. I will contact Kevin Keely at 708.482.7568 or kevin.keely@
gmail.com if I have a concern about my child being photographed during VBS.
Signature: X_______________________________ Date: _____________
This ministry is made possible only through the dedication of
volunteers, like YOU. Please join our fun ‘Laboratory Team’!
For ADULT Volunteer ‘Lab Assistants’:
Your Name________________________________________
E-mail ____________________________________________
Phone #___________________________________________
Before VBS, I can:
*Please note that, in accordance with our Child Protection Policy
and for the safety of our children, training and background check
are required for all applicable adult volunteers. Please see a VBS
Team Member or contact the Church Office for more details.
*Check here if you have had a background check as a volunteer
or employee elsewhere and if you give us permission to contact
them regarding the background check. Where? ________________
For YOUTH Volunteer ‘Lab Assistants’:
Help with VBS Planning
Help with decorations
Your Name_____________________________________________
During VBS, I can (check all that apply):
Grade—Fall ‘15: _______
Pray for children, leaders & parents
Particular Area I’m interested in: ___________________________
Be a substitute ‘Lab Assistant’
I am available on (Circle all that apply):
Assist as needed
Monday Tuesday Wednesday Thursday Friday
Lead or Assist (circle which) in a particular area (please specify):
________________________________________________________
________________________________________________________
During VBS, I am available to help on (check all that apply):
*MANDATORY VOLUNTEER ORIENTATION
ON SUNDAY, JULY 26, 12:30 P.M.
Monday
Tuesday
Wednesday
Thursday
Friday
Office Use:
Has Iron-on, CD & Songbook
Signed & Gave E-mail Address
Paid (cash or check # _________)
Has Required Child Protection Policy Forms
Form Entered