| T-shirt registration deadline for participants and volunteers is Sunday, May 28, 2023. NOTE: Online registration officially will close on Sunday, June 11, 2023. Walk-in registrations will be allowed on Monday, June 19 when the doors open at 8:45 a.m. only if space allows. Many classes have reached capacity in the past. |
| *Participant's First Name: |
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| *Participant's Last Name: |
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| *Parent/Guardian Name: |
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| *Address: |
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| *City: |
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| *State: |
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| *Zip: |
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*Cell Phone:
(555-555-5555) |
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| *Email: |
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| *Grade in fall of 2023: |
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*Birthday:
(MM/DD/YYYY) |
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| *Gender: |
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| *T-Shirt Size: |
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*Church attendance:
(Do you regularly attend Village Bible Church in Sugar Grove?) |
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Church Name:
(If you attend a different church, please list the name of your home church.) |
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Allergies, Medical & Special Needs:
(Leave blank if not applicable) |
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| *Health Insurance Company: |
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| *Insurance Policy Number: |
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| *Physician's Name: |
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| *Physician's Phone Number: |
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| *Medical authorization in case of an emergency: |
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| *Emergency Contact Name (1): |
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*Emergency Contact Phone (1):
(555-555-5555) |
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| *Authorized Pickup #1: |
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| Authorized Pickup #2: |
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| Comments: |
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