CPC VBS 2025 Registration

Parent/Family information

Parent/Guardian Name

Parent/Guardian Email

This address will receive a confirmation email

Parent/Guardian Phone

Parent/Guardian Address (optional)

Are Parents/Guardians members of Carmichael Presbyterian Church?

Yes No

Alternative Contact's Name

Alternative Contact's Phone

Name of additional person authorized to pick up child/ren (optional)

Child information:

Child's Name

Grade child will enter Fall 2025

Dietary Restrictions

Any known Allergies?

Anything else we should know about the child?

T-shirt size (youth sizes)

XS S M L XL (Adult Small) other

Additional Child information:

2nd Child's Name

Grade 2nd child will enter Fall 2025

Dietary Restrictions for 2nd Child

Any known Allergies for 2nd Child?

Anything else we should know about 2nd child?

2nd Child T-Shirt Size (youth sizes) XS S M L XL (Adult Small) other

Extra Additional Child Information:

3rd Child's Name

Grade 3rd child will enter Fall 2025

Dietary Restrictions for 3rd Child

Any known Allergies for 3rd Child?

Anything else we should know about 3rd child?

3rd Child's T-Shirt Size (youth sizes) XS S M L XL (Adult Small) other

Medical Release

In the event of an accident or other emergency, when a parent is unavailable, I hereby authorize a representative of Carmichael Presbyterian Church to make such arrangements as s/he considers necessary for my child to receive medical or hospital care, including necessary transportation. Under such circumstances, I further authorize the physician named below to undertake such care and treatment of my child, as s/he considers necessary. In the event said physician is not available at the time, I authorize such care and treatment to be performed by a licensed physician or surgeon.

Name of Physician

Physician's Phone Number

Please read and check the box if you agree

I am the legal guardian of the child/ren listed above. I agree to the terms above and by tying my full name below, I recognize this as my electronic signature.

Please type your full name

Payment

Below is a dropbox that has four options. Please select the option that represents how many children you are registering. This is also where you can inquire about scholarships. Thank you!

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

CPC VBS 2025 Registration

Description

Please Fix the Following