(march 2012) june 11 — 15, 2012 - clover...

SonRise National Park VBS Registration Form

(March 2012)

June 11 — 15, 2012

SonRise National Park VBS is open to rising Kindergarteners through 6th graders. One registration form may be used per family, for up to three children. Please complete page two if additional children are enrolling.

Family Information Family Name: Parent Name(s):

Address: City: State: Zip: Home Phone:

Cell Phone (mother):

Cell Phone (father):

E-mail Address: Church Name (if applicable):

Emergency Contact Information (if parent listed above is not available)

Name: Relationship to Participant: Home Number: Cell Phone: The person responsible for picking up child at the end of each camp day (if different than parent) Name: Cell Phone: Registration Information *There is a maximum fee of $25.00 per family. Child #1: $10.00

Name: Birthdate (mm/dd/yy):

Grade (as of Fall 2012):

Gender: ¨ M ¨ F T-shirt size: ¨ Youth-S ¨ Youth-M ¨ Youth-L ¨ Adult-M

Child #2: $10.00

Name: Birthdate (mm/dd/yy):

Grade (as of Fall 2012):

Gender: ¨ M ¨ F T-shirt size: ¨ Youth-S ¨ Youth-M ¨ Youth-L ¨ Adult-M

Child #3: $5.00

Name: Birthdate (mm/dd/yy):

Grade (as of Fall 2012):

Gender: ¨ M ¨ F T-shirt size: ¨ Youth-S ¨ Youth-M ¨ Youth-L ¨ Adult-M

Signature (Parent/Guardian): Date: Please send completed Registration Form and Medical Release Form, along with payment to: Grace Pointe Church-Plainfield Campus, P.O. Box 1330, Plainfield, IL, 60544, attn. Lori Healy. For additional information, please contact Karen Yang at 815-715-2706 or karen.kulzick@kismetconsulting.com. Our website is www.gracepointeplainfield.us.

SonRise National Park VBS Registration Form (March 2012) Page Two Registration Information *There is a maximum fee of $25.00 per family. Child #4: No Charge

Name: Birthdate (mm/dd/yy):

Grade (as of Fall 2012):

Gender: ¨ M ¨ F T-shirt size: ¨ Youth-S ¨ Youth-M ¨ Youth-L ¨ Adult-M

Child #5: No Charge

Name: Birthdate (mm/dd/yy):

Grade (as of Fall 2012):

Gender: ¨ M ¨ F T-shirt size: ¨ Youth-S ¨ Youth-M ¨ Youth-L ¨ Adult-M

Child #6: No Charge

Name: Birthdate (mm/dd/yy):

Grade (as of Fall 2012):

Gender: ¨ M ¨ F T-shirt size: ¨ Youth-S ¨ Youth-M ¨ Youth-L ¨ Adult-M

Signature (Parent/Guardian): Date: Please send completed Registration Form and Medical Release Form, along with payment to: Grace Pointe Church-Plainfield Campus, P.O. Box 1330, Plainfield, IL, 60544, attn. Lori Healy. For additional information, please contact Karen Yang at 815-715-2706 or karen.kulzick@kismetconsulting.com. Our website is www.gracepointeplainfield.us.