To register your child(ren) for Vacation Bible School, please fill out this form completely and click "Submit". It's that Easy!

Contact us at 402-421-3704, southernheightspresbyterian@gmail.com, or by using this form if you have any questions or if you need to register more than four children.

Parent/Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Registered Child 1

Please list: Name, Age, Grade for 2022-2023 School Year, Gender, Allergies and/or Medical Conditions.

Registered Child 2

Please list: Name, Age, Grade for 2022-2023 School Year, Gender, Allergies and/or Medical Conditions.

Registered Child 3

Please list: Name, Age, Grade for 2022-2023 School Year, Gender, Allergies and/or Medical Conditions.

Registered Child 4

Please list: Name, Age, Grade for 2022-2023 School Year, Gender, Allergies and/or Medical Conditions.

TShirt Sizes

Please enter the size of t-shirts needed for each participant

Evening Meals - Number

Will your children be eating with us? How many? If adults will be joining, please Indicate that as well.

Emergency Contact

Please list the name and phone number of an adult to contact in the event that you are not available.

Pick Up Restrictions

Please list any persons *not* allowed to pick up registered children from VBS.

Photo Release

I give permission for Southern Heights Presbyterian Church to take and use photos of my child/ren for the end of VBS Slideshow and also in other publications and promotional materials, including (but not limited to), inclusion in the monthly newsletter, weekly hotline, posting to the southernheights.org website, facebook, twitter, and instagram pages.

Yes

Liability Release

I understand that participation in this program is not without risk, and so release, forever discharge and agree to hold harmless Southern Heights Presbyterian Church, the staff and volunteers of this organization, as well as any parent organizations (Presbytery, Synod, General Assembly) from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred while my child is participating in the program. Further, I hereby assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in the program.  I also agree to hold harmless and indemnify said church, its directors, employees, and agents, for any liability sustained by said church as the result of the negligent, willful, or intentional acts of my child, including any expenses incurred by those acts. By checking the following box, I declare that I understand and am in agreement with these statements.

I Agree