Online Registration for Children

Child's Name

Prefers to be called

Male Female

Birthday (mm/dd/yyyy)

Age (as of July 6, 2008)

Grade (completed by May 2008)

Address 1 Address 2

City State Zip

Home phone #

Home Church

Email

Parent/Guardian 1 Name Cell#

Parent/Guardian 2 Name Cell #

Who may pick up the child?

Please list any allergies, medical conditions, or special needs that our VBS staff should know about should know about.

Can your child's photograph be used in the VBS slideshow and in church news articles in print and on the church website? Individual children are not identified (named) in these pictures.
Yes, it is OK to use my child's picture
No, do not use my child's picture

Doctor's Name Doctor's phone#

Keep going, we're almost finished.

When you check in on the first day, a parent/guardian must sign the following release:

In the event that I cannot be reached to make arrangements for emergency medical care, I, _______, give my authorization and consent for authorized VBS personnel to consent to emergency treatment of my child. As parent/guardian, I accept the policies and regulations of the church and release the church and VBS workers/volunteers from any liability resulting from conditions beyond its control.

Optional Items:

Our VBS is free to participate in, but donations are accepted. The following items are optional. If they are preordered now, you will recieve them on the first day of VBS. A limited number of each item may be available for sale at VBS for those who do not preorder.

2008 VBS T-Shirt---$8.00
YXS YS YM YL AS AM AL AXL

Take-Home CD-ROM ---$4.00
This disc contains games for the computer and 9 Beach Party VBS songs. The music can be played on a computer or regular CD player. This CD does NOT contain any music by our camp music leader, Joel Sprayberry. Preview this music at

Take Home Cassette ---$3.00
This disc contains 9 songs. This cassette does NOT contain any music by our camp music leader, Joel Sprayberry.

Checks should be made payable to "PSUMC-VBS." Please write your child's name in the memo. Payment for preordered items may be brought on the first day of camp or checks may be mailed to PSUMC VBS, 1401 S. Polk St, Amarillo, TX 79101

Please contact the church office with any questions or problems at 806-374-2891