MercyKids - VBS 2023: Twist & Turns

Participant Registration

If you or your child would like to participate in this event as a Participant, please complete the following form.

(If you are under 18, please have your parent or guardian complete the form.)

If you have previously registered with us for a prior event, you can search for your stored information instead of filling out the form below.

Personal Information

*Participant's First Name:
*Participant's Last Name:
*Preferred Name for Name Tag:
*Gender:
*Birthday: (MM/DD/YYYY)
*Last Grade Completed:
Allergies, Medical, & Special Needs: (Leave Blank if None)
*Parent/Guardian Name:
*Address:
*City:
*State:
*Zip:
*Cell Phone: (555-555-5555)
*Cell Phone Carrier:
*Email:
*Emergency Contact Name (1):
*Emergency Contact Phone (1): (555-555-5555)
*Emergency Contact Name (2):
*Emergency Contact Phone (2): (555-555-5555)
*Authorized Pickup #1:
*Authorized Pickup #2:
Do you attend Mercy Church?:
If so, which campus do you attend?:
Do you attend another church?:
If so, which church?:
*Photograph Use: (Photos will be taken throughout VBS & may be used in various ways on the Mercy website, in printed materials, & on social media. Do you give consent to photos of your child to be used?)