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To contact the Church office call 519-631-7570 or email office@1stunitedchurch.ca
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Our New Canadian Family
Vacation Bible School Registration Form 2017
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Indicates required field
Child's Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Home Phone #
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Birthdate
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Age
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Grade in September 2017
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Home Church, if any
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Parent/Guardian's Name
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First
Last
Home/Work/Cell phone #
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Emergency Contact Name
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Emergency Contact Phone #
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Health Card Number
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Version Code on Health Card
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Family Doctor
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Doctor's Phone #
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Any Allergies? Please specify
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Any Health/Other Information we should know?
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Will medication be required while at VBC?
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YES
NO
If yes, please specify
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Would you be able to help with snack time by coming and serving snack?
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YES
NO
Please initial
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Date
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By submitting this application, the parents/guardians of the child agree on behalf of themselves and the child that any photographs taken of the child may be used without charge by the church/camp in any promotional material, unless a written letter is submitted that states otherwise.
Submit