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York River VBS Participants 2019 on Monday, June 24, 2019

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**Attendee above should be the child, not the parent. Email address above is not a required field.**
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*Parent/Guardian Name:
Parent/Guardian Contact Number:
*Would you like to receive text updates during VBS?:
*Parent/Guardian Email:
*Child's Gender:
*Child's Birthdate (MM/DD/YYYY):
*Age as of June 24, 2019:
*Are you a member or regular attendee of Liberty?:
If you attend another church, where do you attend?:
Our church cares for the success and safety of each participant inside our Kids Ministry. Does your child have an allergy, medical condition, learning difference, disability or any other special need of which our ministry team should be aware?  (leave blank if none)
*Emergency Contact Name (1):
*Emergency Contact Phone (1) (555-555-5555):
Emergency Contact Name (2):
Emergency Contact Phone (2) (555-555-5555):
*Authorized Pickup #1:
Authorized Pickup #2:
Authorized Pickup #3:
Authorized Pickup #4:
*This event will be photographed and videoed for promotional purposes. Do you give consent for your child to be photographed and videoed?
*To what address would you like us to mail your child's pick-up tags?:
Do you have a special request for your child?:
We will do our best to accommodate special requests, but we prefer to keep groups grade or age specific.

If you would like to volunteer to help with VBS, please click here.

If you would like to register another child, please click 'Next' and then click 'Add Another Person'