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Participant Registration

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Registro en Español

Glencairn Church

Location

725 Erinbrook Dr.

Kitchener, ON N2E 3E3

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Contact Glencairn Church:

519-579-8741

office@glencairn.ca

First, Tell Us About Yourself:

Parent Information

Note: This year's registration fee is $25 per child, which we will collect from you on the first day.

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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Contact Phone 2

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Please provide an emergency contact who is not the child's parent/guardian. We will contact this person in the case that the parents cannot be reached.

Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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I understand that Glencairn Church is a nonprofit charitable institution, which is voluntarily presenting this program for my child and the community. I also understand that the program has activities that can result in physical injury to my child. I therefore release and discharge all liability for any harm or injury suffered as a result of my child's participation in the program.

I consent to let program leaders seek medical attention for my child if I cannot be reached and immediate attention is deemed by the program leaders to be required.

By registering my child for this program, I consent that their photo may be taken and be used in promotional material within the church.

I agree

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I give permission to have my child's picture shown online on Glencairn's website and social media pages.

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On Thursday, July 25, there will be a free hot dog lunch for all VBC participants, and their family members after VBC ends for that day at noon. We hope you can come!

How many people from your family (including VBC participants) will plan to attend lunch on Thursday?

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If you go to a local church, which one do you attend?

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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

Which session will they be attending?

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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Allergies

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Medical Concerns

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What is your child's health card number?

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Your child's health card number will only be used for purposes related to the provision of health care for your child.

Comments

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