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Participant Registration

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Jefferson Baptist Church

Location

15002 Jefferson Hwy 99E SE

Jefferson, OR 97352

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Contact Katie Duke:

541-327-2939

katie@jbc.church

First, Tell Us About Yourself:

Parent Information

I have signed up as a volunteer for VBS! (If you cannot mark yes please wait to register a camper until after April 25)

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First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Country

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Contact Phone 1

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Authorized Adults that can pick camper up (PARENT, INCLUDE YOURSELF AGAIN PLEASE!)

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Photo Permission? (note, if you choose no our photographers will not take their picture at all, including the photo craft. We will never post photos of minors online - even with parents permission)

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Home Church Affiliation

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I want to receive info about Summer/Fall events for Kids/families at JBC!

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

First Name

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Last Name

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Grade Entering

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Gender

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Date Of Birth

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Age as of 8/31 (must be at least 4 and potty trained)

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Allergies

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Please note that some areas may not be physically accessible to individuals with disabilities. If accessibility accommodations are needed, let us know below so we can adjust the rotation schedule accordingly

Medical Concerns

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

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Friend 1 Last Name

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Comments

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