Middlebury Congregational Church VBS 2025 Registration Form

June 23-27- 9:00 am-12:00 pm | Join us for Middlebury Congregational Church's Vacation Bible School: Camp Firelight!
Please fill out this form and click submit. Questions can be sent to sarahubbardmcc@gmail.com

Parent/Guardian Name

This address will receive a confirmation email

Phone

Phone (2)

Address

Child Name (1)

Child 1 Birthdate

Child 1 Grade (2025-26 school year)

Please select one option.

Pre-K 4 K 1 2 3 4 5 6

Child 2 Name

Child 2 Birthdate

Child 2 Grade (2024-25 school year)

Please select one option.

Pre-K 4 K 1 2 3 4 5 6 Option

Child 3 Name

Child 3 Birthdate

Child 3 Grade

Please select one option.

Pre-K 4 K 1 2 3 4 5 6

Emergency Contact: Name, relationship, phone number

Person Responsible for pick-up

Alternative person authorized to pick-up

Are there any legal custody orders of which the church should be made aware?

Please select one option.

Yes No

Does your child(ren) have any allergies, medical conditions, or special needs we should know about? If so, please describe and include any accommodations necessary.

Permissions: Photos may taken and be used for: bulletin boards, publications (Church newsletters, newspaper), MCC website and/or Social Media.

Please select one option.

I acknowledge and agree I do not agree

End of week show may be livestreamed/recorded for families to view. Children may appear in video

Please select one option.

I acknowledge and agree

My child/children has permission to participate in the MCC VBS events between June 23 and June 27, 2025. I understand that I may not hold MCC liable in case of accident or injury to my child. I give permission for medical care to be given should my child need treatment before I am contacted.

Please select one option.

I acknowledge and agree

Payment

Child 1 ($50) 2 Children ($100) 3 Children ($150) 4 Children ($200)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

June 23-27- 9:00 am-12:00 pm

Join us for Middlebury Congregational Church's Vacation Bible School: Camp Firelight!
Please fill out this form and click submit. Questions can be sent to sarahubbardmcc@gmail.com

Middlebury Congregational Church VBS 2025 Registration Form

Description

Please Fix the Following