VBS Registration Form
Trinity Episcopal Church, Upperville Vacation Bible School July 25 - 29, 2022 9:00am - 12:00noon, Monday 25 - Thursday 28 4:00pm - 7:00pm, Friday 29 P.O. Box 127, 9108 John S Mosby Hwy Upperville, VA, 20185 (540)592-3343 www.trinityupperville.org
Trinity Episcopal Church, Upperville
Vacation Bible School June 25 – 29, 2022 Hi there! We’re so glad you’re interested in Vacation Bible School at Trinity Episcopal Church! A little about this year’s program: At “Adventure on Discovery Island”, kids are invited to explore the ways God's great light shines in the world and shows them how they can reflect that light in their own lives. We’ll participate in memorable Bible-learning activities, sing catchy songs, play team-building games, make and dig into yummy treats, experience one-of-a-kind Bible adventures, and make crafts that represent their uniqueness and creativity. Plus, kids will learn to look for evidence of God’s love and light all around them through something called God Sightings. Each day concludes with everyone sharing what they’ve learned and most enjoyed. Age Requirement and Placement: This adventure is available to all children, age 3 through current 5th grade (Children must have turned 3 by June 12, 2022 and be potty-trained). Preschoolers will be placed in separate small groups, and elementary-age children will be placed in small groups of similar age and grade levels. Registration Information: Please complete one registration form per family. The cost of the program is free. Please submit completed forms to: Ben Baker, ben@trinityupperville.org Or leave in Ben’s mailbox, which is located on the table just inside the church office hallway. Or forms may also be mailed to: Trinity Episcopal Church, P.O. Box 127, Upperville, Va, 20185. Registration forms will be accepted on a first-come basis until classes are filled. Preregistration is required. REGISTRATION ENDS ON JULY 18. No walk-ins will be accepted. Volunteer Opportunities: Many volunteers are needed. If you are able to volunteer during VBS week (or part of the week), we need your help! Teens are also encouraged to volunteer. There’s a place for everyone at “Adventure on Discovery Island”! If you are able and willing to help out with our VBS program, but are unable to be there during the daytime, please let us know how and when you might be able to contribute. There are plenty of things that will need to be done in advance. Please fill out the separate volunteer form and return to Ben Baker. If you have any questions or are interested in a volunteer opportunity, please contact: Ben Baker, (540) 592-3343, ben@trinityupperville.org
Trinity Episcopal Church
Vacation Bible School 2022 REGISTRATION FORM Please Print Clearly: Child’s Name: Age*:
Grade (during 2022-2023 school year): Gender: M/F
Date of Birth:
Child’s Name: Age*:
Grade (during 2022-2023 school year): Gender: M/F
Date of Birth:
Child’s Name: Age*:
Grade (during 2017-2018 school year): Gender: M/F
Date of Birth:
*Children must have turned 3 by July 25, 2022, and all children must be potty-trained. Address: City, State, Zip Code: Home Phone:
Email:
Home Church:
Parent(s) or Guardian(s) Name(s):
Attention Parents: Please check below if you can help as a volunteer. We will contact you with more information. I will volunteer at VBS. (please fill out separate form)
Media Release: When participating in church activities, your child may be photographed for print, videotaped or electronically imaged. Images may be used in promotional materials, news releases and other online and published formats for Trinity Church. The images are the sole property of Trinity Church. If you do not want your child’s image used, please check here.
MEDICAL INFORMATION Name of Insurance___________________________________________________________________ ID Numbers ________________________________________________________________________ Name of Primary Care Physician ________________________________________________________ PCP’s Address & Phone Number ________________________________________________________ Child #1 Name ____________________________________________________________________ Medications Used____________________________________________________________________ Medical Allergies or Conditions:_________________________________________________________
Child #2 Name ____________________________________________________________________ Medications Used____________________________________________________________________ Medical Allergies or Conditions:_________________________________________________________ Child #3 Name ____________________________________________________________________ Medications Used____________________________________________________________________ Medical Allergies or Conditions:_________________________________________________________ EMERGENCY CONTACTS Parent/Guardian Information Name of Father or Guardian______________________________
Phone # ____________________ 2nd Phone # ____________________
Name of Mother or Guardian_____________________________
Phone # ____________________ 2nd Phone # ____________________
EMERGENCY CONTACTS: (DIFFERENT FROM PARENTS LISTED ABOVE) First Contact:
_________________________________________________________________________ Name Relationship ________________________________________________________________________ Phone Number 2nd Phone Number
Second Contact: _______________________________________________________________________ Name Relationship _______________________________________________________________________ Phone Number 2nd Phone Number The minor child/ren registered here has my/our permission to participate in the Trinity Episcopal Church “Vacation Bible School, 2022.” In the event of an emergency, I give permission to adult leaders and church staff to seek medical attention for him or her. I understand that every effort will be made to contact the parent(s)/guardian(s) in the event of such an emergency. Parent Signature: Signed __________________________________________ Date:_______________________________ Parent/Guardian