Maker Fun Factory - VBS Registration Form
Maker Fun Factory VBS  will be held from July 9 - 13, 9 AM to 11:30 AM for children age 4 years through entering grade 4.  To register your child, please complete this registration form.  
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Child First Name *
Child Last Name *
Grade Entering, Fall 2018 *
Birthday *
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Parent Email Address *
Street Address *
City *
State *
Zip Code *
Parent Home Phone
Parent Cell Phone *
Parent/Guardian First Name *
Parent/Guardian Last Name *
If your child is a guest of another VBS student,  please list that child's name.
What is your home church, if any?
Emergency Contact Name *
Emergency Contact Relationship *
Emergency Contact Phone Number *
Medical Release - By typing my name below, I, the parent or guardian of the minor child named in this registration form, do hereby authorize adult VBS volunteers of Community Covenant Church, East Bridgewater, MA as agent(s), to consent to any medical care deemed advisable by any accredited physician or surgeon in an approved emergency clinic or hospital.   *
Please list any allergies (include medications, foods, insects, etc.).  If none, please list NA. *
Does your child have any medical, behavioral, or special needs, including medications currently being used? *
If yes, please explain
Doctor's Name *
Doctor's Phone Number *
Please provide names of people with permission to pick up your child at the end of VBS. *
Photo Release - By typing my name below, I give Community Covenant Church permission to use VBS photos of my child on the Church's website and/or in the church's newsletter, with the understanding that his/her name will not be published.
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