Temporary VBS 2024 Posted April 15, 2019 VBS Registration Form 2024 Please register your child for the rising grade level as of Fall 2024. No friend requests will be accepted.Cost ** No Refunds after June 1 **How many children are you enrolling?*Cost is $75 for the 1st child, and $50 for each additional child.1 Child2 Children3 Children4 ChildrenI would also like to purchase... Nothing, thank you, just the registration. Birthday Blast: A Celebration of Life Music CD Total $0.00 Student InformationChild's Full Name* Child's Grade Level as of Fall 2024* Child's T-Shirt Size*Youth SYouth MYouth LAdult SAdult MAdult LAdult XLAdult XXLGender*MaleFemale2nd Child2nd Child's Full Name* 2nd Child's Grade Level as of Fall 2024* 2nd Child's T-Shirt Size*Youth SYouth MYouth LAdult XSAdult SAdult MAdult LAdult XLAdult XXLGender*MaleFemale3rd Child3rd Child's Full Name* 3rd Child's Grade Level as of Fall 2024* 3rd Child's T-Shirt Size*Youth SYouth MYouth LAdult XSAdult SAdult MAdult LAdult XLAdult XXLGender*MaleFemale4th Child4th Child's Full Name* 4th Child's Grade Level as of Fall 2024* 4th Child's T-Shirt Size*Youth SYouth MYouth LAdult SAdult MAdult LAdult XLGender*MaleFemaleAdditional InformationName(s) of Parent(s) or Guardian(s)* Parent Email* Address of Parent(s) or Guardian(s)* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent Home/Cell PhoneParent Work PhoneName of Home Church* Emergency Contact Name*Please name another person other than parents to be notified in an emergency. Emergency Contact Phone*Who may pick up your children from VBS?*Please name the pick-up people.Allergy InformationAllergies: Please explain pertinent allergy information in the box below.Medical/Allergy ReleaseMedical/Allergy Release*Please indicate your agreement with the following medical release: In the event of an emergency or non-emergency situation in which medical treatment is required for my child as a result of participation with the 2024 Vacation Bible School program held at St. Theresa, Ashburn, VA, I authorize the on-site adult leaders, volunteers, and staff members to act as my agents and thereby consent to emergency medical treatment. I understand that every reasonable attempt will be made to contact me in the event of an emergency. I agree with the above medical release. Name of parent digitally signing medical release*Please type your name. Student Drop Off/Pick Up Information*Students cannot be dropped off prior to 8:50AM. Students must be picked up promptly at 12:00PM. PLEASE NOTE: **Only drop off exception is the first day of VBS. Drop off will be at 8:40AM**. I have read and understand the above drop off/pick up procedures. Would you like to volunteer? (registration discount given for adult volunteer)*NoYesYour Registration is Incomplete Without Payment** No Refunds after June 1 **EmailThis field is for validation purposes and should be left unchanged.