1.Children Information:

    Please Print. (Families may include up to 3 children on one form):

    1st Child (Early Bird: $70, Regular $80)

    1st Child's name: (required)

    School Grade (After September 2017) (required)

    T-shirt Sizexssmlxlxxl

    2nd Child (Early Bird: $60, Regular: $70)

    2nd Child's name: (required)

    School Grade (After September 2017) (required)

    T-shirt Sizexssmlxlxxl

    3rd Child (Early Bird: $50, Regular: $60)

    3rd Child's name: (required)

    School Grade (After September 2017) (required)

    T-shirt Sizexssmlxlxxl

    2. Parent Information:

    Your Name(required)

    Your Email (required)

    Your Number(required)

    When can you be a parent volunteer? ($5 discount each day you volunteer) *
    Monday, 8/7Tuesday, 8/8Wednesday 8/9Thursday 8/10None of the daysAll of the daysnone

    3. Medical Release Form:

    Child's Full Name(s)(required)

    Emergency Contact

    Name(s)(required)

    Phone(required)

    I (we) understand that, in the event medical treatment is required, every effort will be made to contact me. However, if I cannot be reached, I give my permission to the staff or sponsor to secure the services of a licensed physician to provide the care necessary, including anesthesia, for my child’s well-being. *

    I agree with this statement

    Please list any medical allergies, medications being taken, medical problems, or other important information: (if none, put N/A) *

    4. Liability Waiver Form:

    I hereby agree to release to the Bread of Life Christian Church of San Diego and all of their representatives from any and all liability in connection with any activities to be held in conjunction with the 2017 VBS—Monday, August 7th to Thursday, August 10th. *

    I agree with this statement

    I am aware that refunds are NOT available *

    I agree with this statement

    I am aware that my child is not considered fully registered UNTIL payment is made BEFORE July 23th *

    I agree with this statement