VBS Registration

Register for Vacation Bible School

Jointly hosted by First Presbyterian Church of Farmington, Antioch Lutheran Church, and North Congregational Church at First Presbyterian Church of Farmington (get directions)

August 9-13, 2010

9:30 - Noon Grades K-5 (entering)

Cost: $15 per child, $30 for registrations received AFTER 8/4/10

Family Name

Child #1 Grade Entering in Fall 2010

Child #2 Grade Entering in Fall 2010

Child #3 Grade Entering in Fall 2010

Child #4 Grade Entering in Fall 2010

Please put my child in the same tribe as

Name of Parent/Guardian

Address City Zip Code

Home Church Email address

Phone numbers use ###-###-#### format:

Home Cell Work

Any allergies or special considerations for your child? If yes, please list:

MEDICAL RELEASE

In the event of an emergency or non-emergency situation in which medical treatment is required for my child(ren) listed above, as a result of participation with the 2010 Vacation Bible School program held at First Presbyterian Church of Farmington, Farmington Hills, Michigan, I authorize the on-site adult leaders, volunteers, and staff members to act as my agent and thereby consent to emergency medical treatment for my child. I understand that every reasonable attempt will be made to contact me in the event of an emergency.

I, , agree to the above medical release.

MEDIA RELEASE

I give permission for my child(ren) listed above to be photographed by representatives of Antioch Lutheran Church, First Presbyterian Church of Farmington, or North Congregational Church for use in their publicity materials including, but not limited to, church brochures, bulletin boards, and websites. I understand that no names will be used in any publicity materials.

I, , agree to the above media release I, , DO NOT agree to the above media release

Please make checks payable to First Presbyterian Church of Farmington and write "VBS" on the memo line. Checks can be mailed to: First Presbyterian Church of Farmington, 26165 Farmington Road, Farmington Hills, MI 48334.