Register Me for Mystery Island!

June 13-17, 2021 6:00–8:30 PM | Please fill out this form for each child you wish to register and click submit. We are excited to serve you during this year's VBS!

Information

Child's Name

Gender

Please select one option.

Male Female

Birthdate

Grade Completed

Please select one option.

Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Address

Guardian's Name

Guardian's Phone

This address will receive a confirmation email

Who can pick up your child?

Food Allergies?

Please select one option.

Yes No

If yes, please list:

Medical or Medicinal Concerns?

Please select one option.

Yes No

If yes, please explain:

Permission to Use Images and Video

I hereby grant permission for INDIAN CREEK BAPTIST CHURCH to record sounds, images, or video of my child while attending this VBS program. I also give permission for INDIAN CREEK BAPTIST CHURCH at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media platforms) owned by INDIAN CREEK BAPTIST CHURCH in relation to this VBS program.

Do you consent to the above statement?

Please select one option.

Yes No

SIGNATURE

Date

PLEASE BRING A BEACH TOWEL EACH DAY AND CLOTHES THAT CAN GET WET! Please no swimsuits.

We are excited to see you at VBS 2021!

Description

June 13-17, 2021 6:00–8:30 PM

Please fill out this form for each child you wish to register and click submit. We are excited to serve you during this year's VBS!

Register Me for Mystery Island!

Description

Please Fix the Following