LIALC Children's Time Lab VBS Registration

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On Monday, August 13 to Friday, August 17, 2018 at 9:00am to 12:45pm, with optional extended hours until 5:00pm.

One child per registration form. Return a signed LIALC VBS Permission Form on the first day of VBS on Monday, August 13th when your child is checked in. Children without a signed parental consent form will not be accepted. Thank you for your understanding.

Child's First Name *

Child's Last Name *

Child's Date of Birth *

YYYY

Completed School Year (in 2017-2018) *

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Medical information we need to know, including food allergies *

Home Street Address *

City *

State and Zip code *

Home Phone Number *

Email *

Name of Primary Guardian *

Cell Phone Number of Primary Guardian *

Name of Secondary Guardian *

Cell Phone of Secondary Guardian *

Dismissal: Who may pick up your child at the end of each VBS day? *

[Name, Relationship, Phone number]

Will your child enroll in extended care hours between 12:45-5:00pm (following the end of regular VBS at 12:45pm)? [Specify time of pick-up.] *

Parent Signature *

Date *

YYYY

May we have permission to photograph your child for the VBS video? *

Yes

Does your family attend church regularly?

How did you hear about us?

Comments

The Authority of the Statement of Faith *

Our statement of faith does not exhaust the extent of our faith. The Bible itself is the sole and final source of all that we believe. We do believe, however, that the statement of faith accurately represents the teachings of the Bible and, therefore, is binding upon all members, staff, and volunteers. All literature, whether print or electronic, used in the church shall be in complete agreement with the statement of faith. All activities permitted or performed in any facilities owned, rented, or leased by this church or engaged in by any member of the church staff (volunteer or paid) and all decisions of the administration of this church shall not conflict with the statement of faith. In all conflicts regarding interpretation of the statement of faith, the pastor and board, on behalf of the church, have the final authority.

I understand the VBS policies are consistent with the LIALC's Statement of Faith.

I would like to provide further information for the Activity Consent and Release.

I would like to provide further information for the Medical Information Authorization and Release.

Required

Thank you for registering your child. *

If your child is enrolled for the optional extended care, there is a $30 fee per child for the week. Kindly mail or drop this off to LIALC (LIALC VBS, 7-19 East Marie Street, Hicksville NY 11801) and you will be sent a confirmation once payment is received. For any questions or concerns, contact the Church at 516-938-1245, or email children@lialc.org.

I will return a signed LIALC VBS Parental Consent Form on the first day of VBS on Monday, August 13th when my child is checked in.

Required

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