Mt. Horeb VBS Registration

Registration for SCUBA VBS at Mt. Horeb Church

June 10-13, 2024 is our main VBS week

Children from 4 years old through children that are completing 5th grade will be registered for this session.

June 4-6, 2024 is our session for older Special Needs children and adults

Special Needs adults and children 12 years of age and older will be registered for this session.

More information is available on our VBS information web site.

Parent/Guardian First Name

Parent/Guardian Last Name

Street Address

City | State | Zip Code

Contact Phone Numbers

E-Mail Address

Emergency Contact
Full Name

Emergency Contact Relationship

Emergency Contact Phone

Child's First Name
Goes By

Please enter only the name you want your child to be called by others.
What you enter here will be on your child's nametag.

Child's Last Name

Gender

Home Church
if applicable

Child's Date of Birth
Must be 4 by June 1, 2024.

Grade Completed
This Spring

Session Attending

The session you selected is full. If you continue your child will be placed on the waitlist. If you are volunteering during the session that you selected, please complete your registration and then e-mail vbs@mthorebchurch.org. Your child will be accommodated.

Allergies

Does your child have any allergies?
Yes No

Medical

Does your child have any medical conditions or special needs (physical, learning, or behavioral) we should be aware of?
Yes No

Shadow/Buddy

Based on your child's needs, would a shadow or buddy be beneficial?
Yes No

If your child's needs warrant special handling during VBS you will be contacted by a nurse prior to the first day.

Security/Safe Word

Please enter a safe word that can be used to pick up your child from VBS. We will not allow anyone to pick up your child without this word. Anyone with this word will be permitted to pick up your child.

Friend Request
Optional - Limit 1

You may optionally enter the first and last name of ONE friend that you would like to be placed in the same crew as your child. Friends must request each other and also register for the same session and be in the same age group. Friend requests are not guaranteed but we will make every effort to place them in the same crew. If a friend request has more than one name listed, it cannot be honored.

Medical Consent

By checking this box, you give permission for the VBS Staff at Mt. Horeb to provide and secure medical treatment for your child, including transportation and hospitalization, in the event of an emergency. Your consent is required in order to register your child for VBS.

I Consent

Photo Consent

By checking this box, you give permission for photos taken during VBS to be used for promotional purposes including printed, electronic, and church social media. Your consent is required in order to register your child for VBS.

I Consent

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