EmailMe Form - VBS Form | Pre-K thru 12th Grade

*NOTE: We are asking that 3 year olds are potty trained should they attend VBS. If not, we are requiring parents to remain with them.

Child's Name *

Age *

Gender *

Male

Female

Grade level for the 2024-2025 year.

What grade are they (2024-2025 school year)? *

Parent / Guardian's Name *

Parent / Guardian's Email *

Address *

Street Address City State / Province / Region Postal / Zip Code

Home Phone *

Cell Phone *

Would you like to receive text messages regarding VBS and any future VBS information/communication? By selecting "Yes" you give New Jerusalem M.B. Church permission to send you text messages regarding VBS and future VBS communication. *

Yes

No

Emergency Information

Emergency Contact Name *

Emergency Number *

Medical

Food Allergies / Medical Issues *

Yes

No

If yes, please list them all here:

Dismissal / Pickup

How will your child be picked up each night? *

Pickup

Other

If other, please indicate how your child will get home.

Permission to use your child's photograph in church publications (printed pieces and church website)? *

Yes

No

Release Disclaimer and Electronic Signature: I certify that all the information in my registration submission is accurate and true. I release New Jerusalem MB Church and Springfield MB Church of all liability of above named person while participating in Vacation Bible School in said time June 17-21, 2024.

Special Note:

We encourage ages 3 years to 18 years to wear tennis shoes for recreation activities. 3 years to 18 years will be at Greater Spring and 19 and older will be at New Jerusalem.

VBS Disclaimer

We don't (New Jerusalem M. B. Church) disclose information (personal or general) collected by our site, via our online forms. Although, we won't ever ask for your personal information like Social Security Numbers, Account Numbers, etc.

We only use information collected from our online forms to tally a count of participants for events and to contact them in case of event updates and changes, to respond to members (if the online form is specifically for members of New Jerusalem), or to share any other pertinent communication that's needed, after online form information is submitted.

Parent and/or Guardian, leave your electronic signature. Thank you! *

Clear

Please retype your name below. Thank you! *