2022 VBS Registration • Campbell Baptist Church

Child's name *

Age (as of July 1, 2022) *

Child's School Grade in September 2022

Child's Ontario Health Card #

Parent/Guardian Name: *

Address

Telephone #

Did a friend invite you? If so, friend's name.

If you attend church, where do you attend?

Would any of your children like to be placed in the same group as one of their friends? If so, who?

In case of a medical emergency, I hereby give authority to any hospital and/or emergency medical personnel to render immediate medical aid, including transport if necessary, for the child(ren) listed, as may be required at the time for their health and safety. *

Yes, I consent.

No, I do not consent.

If you have additional children attending, please fill out their information below.

If you are done, click the SUBMIT button at the bottom of the page.

Child #2

Child's Name #2

Child's Age #2 (as of July 1, 2022)

Child #2 School Grade in September 2022

Child #2 Ontario Health Card Number

Child #3

Child's Name #3

Child's Age #3 (as of July 1, 2022)

Child #3 School Grade in September 2022

Child #3 Ontario Health Card Number

Child #4

Child's Name #4

Child's Age #4 (as of July 1, 2022)

Child #4 School Grade in September 2022

Child #4 Ontario Health Card Number

Child #5

Child's Name #5

Child's Age #5 (as of July 1, 2022)

Child #5 School Grade in September 2022

Child #5 Ontario Health Card Number