Theme image

Registracion del Participante

Go Back

LifePointe Alliance Church

Location

997 Route 228

Mars, PA 16046

Map It

Contact Misty Cope:

724-776-9400

misty.cope@lifepointealliance.org

Primero, cuéntenos sobre usted:

Información de los Padres

Nombre

This field is required.

Apellido

This field is required.

Correo Electrónico

This field is required.

Dirección 1

This field is required.

Dirección 2

This field is required.

Ciudad

This field is required.

Estado/Provincia

This field is required.

ZIP/Código Postal

This field is required.

Teléfono de Contacto 1

This field is required.

Teléfono de Contacto 2

This field is required.

Nombre del Contacto de Emergencia

This field is required.

Relación del Contacto de Emergencia

This field is required.

Teléfono del Contacto de Emergencia

This field is required.

Nombre de recogida alternativo

This field is required.

Teléfono de recogida alternativa

This field is required.

Nombre alternativo de recogida 2

This field is required.

Teléfono alternativo de recogida 2

This field is required.

Afiliación de la iglesia local

This field is required.

Please scroll down past the ad to enter student information.

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.

Cuéntanos sobre tu participante

Nombre

This field is required.

Apellido

This field is required.

Please enter the grade level for the 2026-2027 school year.

Grado Entrando

This field is required.

Género

This field is required.

Fecha de nacimiento

This field is required.

Alergias

This field is required.

Preocupaciones Médicas

This field is required.

Comentarios

This field is required.

Photographs will be taken throughout VBS both for daily viewing and publicity/promotional purposes, which include, but are not limited to, in-house presentations, church web site, social media, brochures and newsletters. By signing below, you are granting the church to use photographs of the above mentioned minor(s) as stated. (Please type name below to indicate photo consent)

This field is required.

As a parent/guardian, I give my permission for the above minor to attend Vacation Bible School at LifePointe Alliance Church. I authorize treatment under the direction of any licensed physician of the above minor in the event of a medical emergency which in the opinion of the attending physician may endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted after reasonable effort has been made to reach me by phone. I will not hold the church, or their staff, administration, or workers, liable for any injury to or loss of possessions by the above minor during any activity on the church property. (Please type name below to indicate permission regarding medical care)

This field is required.

— or —