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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 Marleah Doyle:

610-395-3613 ext 19

vmdoyle@bethanyumchurch.com

First, tell us about yourself:

Parent Information

Registration for Bethany VBS June 20-June 24 (Macungie campus)

AM session 9:15am-12:00pm

All children 4 yrs old to 5th grade welcome!

*Children must be at least 4 years of age by June 20, 2022 to participate in VBS.

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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All persons permitted to pick up child from VBS (including yourself). Please include first and last name, and list family members together - i.e. John & Jane Doe.

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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Tell Us About Your Participant

Pease enter PARTICIPANT information

First Name

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Last Name

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Gender

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*Children must be at least 4 years of age by June 20, 2022 to participate in VBS.

My child meets the 4 years of age minimum by June 20, 2022

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Date Of Birth

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Grade Leaving

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Parent / guardian is a VBS volunteer

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Please review the following list of snacks that will be served the week of VBS. If your child cannot have a snack served at VBS, please provide an alternate snack for that day in a bag labeled with your child's name and give it to his or her crew leader.

VBS day	Snack
Monday	Honey Maid Graham Crackers (wheat & soy), Skittles, Lucky Leaf Vanilla Pudding (dairy, gluten & soy)
Tuesday	Lucky Leaf Chocolate Pudding (dairy, gluten & soy), Albanese Gummy Worms (food dyes), Honey Maid Graham Crackers (wheat & soy), Snyder's Pretzel Sticks (wheat)
Wednesday	Cheerios, Wegman's Marshmallows, Wegman's Semi-Sweet Chocolate Morsels, Snyder's Pretzel Sticks (wheat)
Thursday	Sensible Portions Garden Veggie Straws
Friday	Fla-Vor-Ice Freeze Pops

I have reviewed the list of snacks being served during the week of VBS and it is ok for my child to have them.

All snacks are ok

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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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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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Friend 2 First Name

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Friend 2 Last Name

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*Note: children will be placed in crews as follows: preschool, kindergarten, 1st grade, 2nd & 3rd grade combined, 4th & 5th grade combined. If your child would like to be with a friend or sibling who is in a younger age group, both children will be placed in the younger group.

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