Meadow Brook Church VBS Registration Form 2022

• This year we are one again excited to bring VBS to you at the Church! Using our great space here, we will run missions, games, crafts, and snack with your children! If you have any questions/comments/concerns, please reach out to Renee Rocheleau at renee@meadowbrook.ca or at 519-326-3605! WELCOME TO VBS 2022!
• Child's Name*
  First Name

  Last Name
• Child's Birth Date *
  MM

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  DD

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  YYYY
• Age & Grade*
• Child's T-shirt Size*
  >XSSMLXL
• Address *
  Street Address*

  Address Line 2

  City*

  Province / State / Region*

  Postal Code / Zip

  Antigua and BarbudaBahamasBarbadosBelizeCanadaCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNicaraguaPanamaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColumbiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosCongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauCôte d\'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandTanzaniaTogoTunisiaUgandaZambiaZimbabwe

  Country*
• Parent / Guardian*
• Parent/Guardian's Phone Number
   

  (###)

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  -

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• Parent/Guardian's E-mail*
  (Approved email for notification of weekly themes & upcoming events)
   
• Health Infortmation
• Allergies
• Are any of these life threatening?
  >YesNo
• If yes, please explain:
• Does the student have any physical, emotional, mental or behavioral concerns or limitations that our staff should be aware of?*
  >YesNo
• If yes, please explain:
• Other Information: As part of our activities at Meadow Brook Church, photos are often taken during the events of underage students. We require your permission to use them in any of our publications (i.e. flyers, posters, slideshows, etc.). All names/identities of children will be kept confidential, and will not be shared with any third party (i.e. another church, newspaper) without further written consent.
• Please check all that apply:
  Permission granted to use pictures of above mentioned student for IN-HOUSE productions and advertisements.

  Permission granted to use pictures of above mentioned student for EXTERNAL productions and advertisements.
• All reasonable precautions are taken for the safety and health of your child, but in the event of an accident or sickness requiring medical attention, Meadow Brook Church, and its volunteers are hereby released from liability. In the event that your child requires special medical attention, medication, x-rays or treatment, the parents/guardians will be notified immediately.
• We also request that students participating in our programs refrain from bringing unnecessary valuable items with them (e.g., iPods, personal gaming devices, phones, etc.). If these items are brought to any of our programs, it is at the student's own risk, as Meadow Brook Church will not be liable for any loss of damages.
• Terms
• By checking the box below, you acknowledge that you understand and agree to the terms listed above and you grant permission for your child to attend and participate in the FOCUS VBS.*
  I agree
• Your Name *
  First Name

  Last Name
• Date *
  MM

  /

  DD

  /

  YYYY
• Emergency Contact Name*
  First Name

  Last Name
• Emergency Contact Phone Number*