Theme image

Participant Registration

Go Back

Registro en Español

Longview Heights Four Friends Ministry

Location

4501 Goodman Road

Olive Branch, MS 38654

Map It

Contact Lisa Wilson:

662-895-1900

lwilson@lhbc.me

First, Tell Us About Yourself:

Parent Information

Please note: Four Friends Special Needs VBS focuses on our special needs friends. To accomplish this we ask that you only register your child with special needs. We are not able to accommodate siblings for this event. Thank you for your understanding.

This first section is for PARENT/GUARDIAN information. You will enter your child's information afterwards.

First Name

This field is required.

Last Name

This field is required.

Address 1

This field is required.

Address 2

This field is required.

City

This field is required.

State/Province

This field is required.

ZIP/Postal Code

This field is required.

Contact Phone 1

This field is required.

Contact Phone 2

This field is required.

Emergency Contact Name

This field is required.

Emergency Contact Relationship

This field is required.

Emergency Contact Phone

This field is required.

Alternate Pickup Name

This field is required.

Alternate Pickup Phone

This field is required.

Alternate Pickup 2 Name

This field is required.

Alternate Pickup 2 Phone

This field is required.

Comments

This field is required.

Does your family attend a local church

This field is required.

If yes, what church do you attend?

This field is required.

Continue scrolling below to complete PARTICIPANT REGISTRATION.

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

This field is required.

Last Name

This field is required.

Please note: Please choose the last grade completed below. If your participant is an Adult, please choose YOUTH.

Grade Leaving

This field is required.

Gender

This field is required.

Date Of Birth

This field is required.

Allergies

This field is required.

Medical Concerns

This field is required.

Comments

This field is required.

Please give a brief description of your child's diagnosis.

This field is required.

Share with us any useful information that will help our volunteers make your child's experience successful (likes, dislikes, fears, comfort items, etc).

This field is required.

Does your child have any food restrictions?

This field is required.

Toileting Needs:

This field is required.

Will medication need to be administered during VBS?

This field is required.

Information release: I understand that the information shared on this registration form will be shared with my child's VBS leader and rotation leaders. The sharing of this information is to help us meet their needs and allow them to have a successful experience at VBS.

This field is required.

Photo & Video Release: I understand that by allowing my child to participate in this event, that he/she may be photographed and/or videotaped during activities and these photos/videos may be used in promotional materials or media.

This field is required.

T-Shirts - We will not be taking pre-orders for VBS shirts this year. Shirts will be available on a first come, first served basis at VBS. Cost is $10