Vacation Bible School Registration

June 10th-14th, 2013

8:45am-12:00pm

VBS is open to kids who have completed Kindergarten - 5th grade

Online registration open until June 7th.

Walkup registration will open on Monday, June 10th at 8:15am.

VBS is a free event, however, donations are welcome.

NOTE: Required fields will be marked with (*) next to the caption

VBS T-SHIRTS & CD’S

We will have children’s T-shirts and CD’s available for sale on April 14th at the children’s desk on the main floor.

VBS FRIDAY FAMILY FINALE & LUNCH

NEW THIS YEAR!!! Come join us in the Worship Center at 12 Noon for our COLOSSAL COASTER WORLD Friday Family Finale!!!! Your children will WOW you with all that they have learned at VBS. They will perform VBS songs and we will watch the 2013 PCBC VBS Video Recap of our amazing week at Colossal Coaster World! A hotdog lunch ($1/person) will follow at the Pavillion across the street from PCBC. Invite your friends and Family!!!

VBS Missions Project

All monies collected for missions during VBS will go to MUST Ministries (www.mustministries.org), for "Summer Lunches for Children Program".

"COLOSSAL COASTER WORLD" CAMP

The PCBC Recreation Ministry offers an “After VBS” camp from 12:00—5:00PM. For more information and to register online go to www.pcbchurch.org/ministries/recreation/summer-camps

Child's Information:

Child #1 First Name (*)

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Child #1 Last Name (*)

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Child #1 Gender (*)

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Child #1 Birthdate (i.e. mm/dd/yyyy) (*)

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Child's Grade Completed In 2013 (*)

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Child #1 Allergies

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Child #1 Current Medications

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Child #1 Special Needs

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Do you have a second child to add?

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Child #2's Information:

Child #2 First Name (*)

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Child #2 Last Name (*)

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Child #2 Gender (*)

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Child #2 Birthdate (i.e. mm/dd/yyyy) (*)

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Child #2 Grade Completed In 2013 (*)

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Child #2 Allergies

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Child #2 Current Medications

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Child #2 Special Needs

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Do you have a third child to add?

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Child #3's Information:

Child #3 First Name (*)

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Child #3 Last Name (*)

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Child #3 Gender (*)

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Child #3 Birthdate (i.e. mm/dd/yyyy) (*)

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Child #3 Grade Completed In 2013 (*)

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Child #3 Allergies

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Child #3 Current Medications

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Child #3 Special Needs

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Do you have a fourth child to add?

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Child #4's Information:

Child #4 First Name (*)

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Child #4 Last Name (*)

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Child #4 Gender (*)

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Child #4 Birthdate (i.e. mm/dd/yyyy) (*)

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Child #4 Grade Completed In 2013 (*)

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Child #4 Allergies

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Child #4 Current Medications

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Child #4 Special Needs

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NOTE: If you have additional children beyond the four currently listed please complete this current form and then re-submit a new form for the additional children.

Contact Information:

Home Email Adress (*)

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Mom's Information:

First & Last Name

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Cell Number

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Work Number

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Dad's Information:

First & Last Name

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Cell Number

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Work Number

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Other Contact Information:

Home Street Address (*)

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Home City (*)

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Home State (*)

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Home Zip Code (*)

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Home Phone Number (*)

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Emergency Contact Information: (list two people other than the child's parents)

Name (*)

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Phone Number (*)

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Name

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Phone Number

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General Information:

Number, including your child, attending the VBS Family Finale & Lunch (June 14th at 12pm)

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Additional Notes

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What Church Do You Regularly Attend (please type PCBC if it is your church home)?

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Non-PCBC Members Only:

Would Your Child Like To Be In A Room With A Friend? (enter friends name below)

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Would you like more information about PCBC Church activities?
YesNo
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Authorization for Release or Emergency Care Form

This portion must be completely filled out for your child to be registered.

Permission is granted for the officials, staff, volunteers of Peachtree Corners Baptist Church to administer First Aid, to obtain the services of a Licensed Physician, and to arrange transportation to nearest hospital in case the child named above is seriously ill, injured or requires hospitalization.
Permission is also granted to the Attending Physicians to render whatever treatment they deem necessary for the child's welfare. The responsibility for all expenses incurred will be assumed by the individuals whose signature appears below.
I hereby release and discharge the staff of Peachtree Corners Baptist Church and its volunteers from any and all liability in case of accident or any other injury which might occur to my child through administering First Aid or transportation to a medical facility. I hereby release any and all of the above from any liabilities because of any injury or damage which might occur while in the care of the staff and volunteers.
I hereby give permission for Peachtree Corners Baptist Church to use any pictures taken at this event for publication.

Insurance Company Name (*)

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Insurance Company Phone Number (*)

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Name of Insured (*)

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Insurance Policy Number (*)

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Insurance Group Number (*)

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By initialing the following you are granting Representatives of Peachtree Corners Baptist Church

Permission to Seek Emergency Care (*)

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Permission to use photographs (*)

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Anti-SPAM

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…to know Jesus and make Him known