Theme image

Participant Registration

Go Back

Registro en Español

Venice Free Methodist Church

Location

4871 S. Centinela Ave.

Los Angeles, CA 90066

Map It

Contact Ken Koshimizu:

310-367-0388

kids@venicechurch.org

First, Tell Us About Yourself:

Parent Information

Please note:

Photographs of participating children are used as a part of craft activities, a slide show, social media, and marketing purposes. By attending VBS, you are granting Venice Free Methodist Church permission to photograph your child for these activities.

In case of an emergency, please list someone for us to contact if we are unable to reach the listed parent/guardian.

IMPORTANT: Please list ALL alternate adults who are authorized to pick up your child from VBS. This includes the parents of children who you might carpool with. We check IDs (i.e. Driver's License) to ensure your child is released to the appropriate person. We cannot make edits to this list on the week of VBS as it slows down our check-in and check-out process

First Name

This field is required.

Last Name

This field is required.

Other Parent/Guardian (authorized to pickup)

This field is required.

Other parent phone number

This field is required.

Address 1

This field is required.

City

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.

Text Message Phone

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.

Alternate pickup 3 name

This field is required.

Alternate pickup 3 phone

This field is required.

Alternate pickup 4 name

This field is required.

Alternate pickup 4 phone

This field is required.

Home Church Affiliation

This field is required.

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.

Date Of Birth

This field is required.

Grade Entering

This field is required.

Gender

This field is required.

Shirt Size

This field is required.

Allergies

This field is required.

Medical Concerns

This field is required.

Is this your child's first time attending VBS at Venice FMC?

This field is required.

If yes, how did you hear about VBS?

This field is required.

Comments

This field is required.

— or —