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Participant Registration

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Bethany Church Maungie Campus

Location

Macungie Campus

3801 North Brookside Rd

Allentown, PA 18062

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Contact Landon Hevalow:

610-395-3613

lhevalow@bethanyumchurch.com

First, Tell Us About Yourself:

Parent Information

Registration for Bethany Youth VBS June 23-June 27 (Macungie campus)

Afternoon youth session 12:45pm-2:00pm, Sunday-Thursday.

All children 5th-12th grade welcome!

New this year, our 5th and 6th grader's are invited to a VBS specialty program designed for them. Beginning at 12:45pm, 5th through 12th grade is invited to participate in the VBS environment while learning the lessons in a much deeper and meaningful way for their age. Youth VBS will run Sunday, June 23 through Thursday, June 27th.

Our 6th grade students are still invited to volunteer at the children's VBS in the mornings, bring a lunch, and stay for their own VBS. 5th grade students are invited to arrive at 12:45pm.

Please enter PARENT / GUARDIAN information

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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Contact Phone 1

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Contact Phone 2

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Emergency Contact Name

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Emergency Contact Phone

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Emergency Contact Relationship

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List all persons permitted to pick up child. Please include your name if you will be picking up. Please include first and last name, and list family members together - i.e. John & Jane Doe. Only people listed will be permitted to pick up child.

Persons permitted to pick up

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Photograph and Video Release: I grant Bethany Church, its representatives and employees the right to take photographs of my child and their property in connection with church promotions.

Photo/ Video Release

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Medical Release: I understand that in the event medical intervention is needed, every attempt will be made to contact the persons listed on this registration form. In the event I cannot be reached in an emergency, I hereby give permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or to order an injection, anesthesia, or surgery for my child as deemed necessary.

Accept Medical Release

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Liability Release: I understand all reasonable safety precautions will be taken at all times by Bethany Church and its agents. I understand the possibility of unforeseen hazards and know the inherent possibly of risk. I agree not to hold Bethany Church, its leaders, employees and volunteer staff liable for damages, losses, diseases or injuries incurred by the subject of this form.

Accept Liability Release

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Church Affiliation

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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

*This event is for youth, 5th-12th grades.

Pease enter PARTICIPANT information

First Name

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Last Name

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Gender

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Grade Leaving

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Please provide information about your child's allergies. If your child requires an EPI pen, please indicate that below. During the week of VBS please provide one in a bag labeled with the child's name and give it to his or her crew leader. If your child doesn't have allergies, please enter 'None'.

Allergies

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Please provide information about your child's medical or special needs. If none, leave this field blank.

Medical/Special Needs

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Comments

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