Rolling River Registration Form

Rolling River Rampage Vacation Bible School


June 25-28


9:00-11:30 am


Registration Deadline is June 18 (or until registration limit is reached)


Our Rolling River registration is a two step process: 1. Child(ren)s registration and information form. A separate registration form is required for each child. 2. The Rolling River Rampage Payment Form.


Once we have received your completed registration form and fee, you will be emailed the Photo Release Form and the Medical Release Form, both of which must be completed by June 12. Your paid registration reserves your spot. Thank You for joining us at Rolling River Rampage.
Child's Name*
Please use YOUR name as parent/guardian on the Rolling River Rampage Payment Form. Your child(ren)'s name(s) will connect to your name through this registration form so we will know who you paid for.
Parent/Guardian Name*
Address*
City:*
State:*
Zip Code:*
Email Address:*
Home
Cell
Work
Child's Date of Birth*
Child's Age*
Child's Last grade completed:
Child's t-shirt size (S, M, L, XL)
In case of emergency (when parent/guardian cannot be reached), please contact:
Name*
Phone*
Name*
Phone*
Child's List of Allergies:*
Child's allergy plan
What would you like us to know about your child?
Does your child have any special needs that we need to be aware of (e.g., learning disabilities, emotional challenges, physical disabilities, sensory integration). Please be honest in answering this question. This helps us in planning and preparation. You may be asked to stay with your child, in order for your child to experience the week.
Adults (other than parent/guardian) who may pick up your child(ren)
Name
Phone
Name
Phone
Please remember, this is not the payment for your child(ren). You will need to fill out the Rolling River Rampage Payment Form separately after you submit this form. Thank You!
This registration is submitted by:*


Submit