| 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: |
__________________________________ |
| *Participant's Last Name: |
__________________________________ |
| *Parent/Guardian Name: |
__________________________________ |
| *Address: |
__________________________________ |
| *City: |
__________________________________ |
| *State: |
__________________________________ |
| *Zip: |
__________________________________ |
| *Cell Phone: |
(______)______-________ |
| *Email: |
__________________________________ |
| *Grade in fall of 2023: |
__________________________________ |
| *Birthday: |
__________________________________ |
| *Gender: |
Male Female (circle one) |
| *T-Shirt Size: |
__________________________________ |
| *Church attendance: |
Yes, we attend VBC SG.
No, we attend a different church.
No, we do not have a home church. (circle one) |
| Church Name: |
__________________________________ |
| Allergies, Medical & Special Needs: |
__________________________________ |
| *Health Insurance Company: |
__________________________________ |
| *Insurance Policy Number: |
__________________________________ |
| *Physician's Name: |
__________________________________ |
| *Physician's Phone Number: |
(______)______-________ |
| *Medical authorization in case of an emergency: |
Y N (circle one) |
| *Emergency Contact Name (1): |
__________________________________ |
| *Emergency Contact Phone (1): |
(______)______-________ |
| *Authorized Pickup #1: |
__________________________________ |
| Authorized Pickup #2: |
__________________________________ |
| Comments: |
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