Vacation Bible School - Student Sign up Form
Christian Life Center Houston
Name of the Child
First Name
Last Name
Age
Shirt Size
Gender
Male
Female
Grade Level
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Home Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Does your child have any allergies?
Yes
No
What are the allergies of your child?
Is he/she carrying an Epi-pen at all times?
Yes
No
Does your child have any medical condition that we should be aware of?
Yes
No
What is this medical condition? Please elaborate below:
Pick Up Authorization
Authorized person/s to pickup your child after the Vacation Bible Study
Full Name 1
First Name
Last Name
Relationship
Would you like to attend Adult VBS Class?
Yes
No
Shirt Size
Note: Adult VBS is free with a child registration fee.
Full Name 2
First Name
Last Name
Relationship
Would you like to attend Adult VBS Class?
Yes
No
Shirt Size
Note: Adult VBS is free with a child registration fee.
Emergency Contact Information
Emergency Contact 1
First Name
Last Name
Relationship
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Payment Details
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Early Registration
Price until 04/20/2026.
$
10.00
Regular Registration
$
15.00
Credit Card
Payment Method
Please Select
Cash
Square
Zelle
Reminders
I allow my child to participate in this program.
I hereby authorize the school, bible study conductor, volunteer personnel to conduct first aid, and medical care in the event of an emergency situation. I agreed to pay for all the medical care expenses and costs in a given situation that medical care is needed. (For in-person)
I release the organizers from any liabilities that might happen during the activity and hold them harmless in the event of damages, injuries, or accidents.
I confirm that all information in this form is accurate and true to the best of my knowledge.
Would it be okay if we take photos and videos of the participant during the activity which will be posted in our social media account?
Yes
No
Date
-
Month
-
Day
Year
Date
Parent/Guardian Signature
Submit
Submit
Should be Empty: