VBS Registration — First United Presbyterian Church, Houston PA

Scuba

June 24-28 | 6:00 pm - 8:30 pm

The week will be filled with stories, songs, crafts, science, and snacks. Volunteers welcome & needed to lead & guide children. Station Leaders/Desert Guides will lead groups of children to each station. VBS is open to children 4 years of age through 6th grade.

To register: Please complete this form and submit.

Questions? 724-746-3040 or email: secretary@houstonpresbyterian.org

Student Name

First Name

Last Name

Age

Last Grade Completed

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Allergies / Medical Conditions

Special friend wishes to be with

Father's Name

First Name

Last Name

Father's Phone

(###)

###

####

Mother's Name

First Name

Last Name

Mother's Phone

(###)

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In case of emergency and neither parent can be reached

First Name

Last Name

Phone

(###)

###

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Emergency contact #2

First Name

Last Name

Phone

(###)

###

####

Photo Release: First United Presbyterian Church/VBS has my permission to use my child’s photograph publicly in VBS materials. I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that I will not receive any compensation for publication of photo use.

Parent/Gaurdian/Volunteer's Signature

Date

YYYY

I do not permit photos of my child to be shared

Parent/Guardian/Volunteer's Signature

Date

YYYY

I would like to volunteer as

*Must have PA State Mandated Clearances to Volunteer. Clearances are FREE for volunteers. Obtain at: https://www.compass.state.pa.us/cwis/public/home or https://epatch.state.pa.us/Home.jsp

Crew Helper

Site Helper

I am available to volunteer on

Monday

Tuesday

Wednesday

Thursday

Friday

Name

First Name

Last Name

Phone

(###)

###

####

Scuba

Location

Hours

Contact