2019 VBS CAMPER REGISTRATION
 
2019 VBS CAMPER REGISTRATION
2019 VBS ROAR: This epic African adventure engages the whole herd. At Roar, kids explore God's goodness and celebrate a ferocious faith that powers them through this wild life! For children 4 years old through 5th Grade.
ONLY COMPLETED REGISTRATIONS WILL BE ACCEPTED: Please fill out all fields completely.
PRICES PER CHILD: 1 Child = $35 / 2 Children = $55 / 3 Children = $65 / 4 Children = $75 (use the drop down menu for multiple children)  * 
1st Child’s Name (first & last)  * 
1st Child's Birthday (month, day & year) Ex: 1/1/2011  * 
1st Child's Age  * 
1st Child's Grade / Entering into the 2019-20 School Year (see drop down menu)  * 
1st Child's T-Shirt Size: (see drop down menu)  * 
1st Child: Any Allergies or Special Needs? If so list here:
2nd Child’s Name (first & last)
2nd Child's Birthday (month, day & year) Ex: 1/1/2011
2nd Child's Age
2nd Child's Grade / Entering into the 2019-20 School Year (see drop down menu)
2nd Child's T-Shirt Size: (see drop down menu)
2nd Child: Any Allergies or Special Needs? If so list here:
3rd Child’s Name (first & last)
3rd Child's Birthday (month, day & year)
3rd Child's Age
3rd Child's Grade / Entering into the 2019-20 School Year (see drop down menu)
3rd Child's T-Shirt Size: (see drop down menu)
3rd Child: Any Allergies or Special Needs? If so list here:
4th Child’s Name (first & last)
4th Child's Birthday (month, day & year) Ex: 1/1/2011
4th Child's Age
4th Child's Grade / Entering into the 2019-20 School Year (see drop down menu)
4th Child's T-Shirt Size: (see drop down menu)
Parent Name:  * 
Parent Address (street, city & zip code)  * 
Parent Cell Number:  * 
Emergency Contact Name: (provide this persons cell number below)  * 
Emergency Contact Cell Number:  * 
I give Church of the Palms permission for use of photography including my child in church publicity. (drop down menu)  * 
Your Email Address  * 
Base Price $
Modifications $
Total $
 
 
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