VBS "Camp Chaos"

7/14/25 to 7/18/25 every night from 6:00-8:30pm | Please fill out this form and click submit.

Please fill out a registration form for each child attending.

Parent Information & Emergency Contact

Guardian Name

This address will receive a confirmation email

Phone

Secondary phone number in case of emergency

Relation to child

Child Information

Childs Name

Age or Rising Grade

Please select one option.

3 Years old 4 Years old K5 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

In order to best meet the needs of all our students, please check any/all of the following that may appy.

Please select all that apply.

Allergies. Medication Dietary Rescrictions Special Needs

If you selected any of the above boxes, please note any special accommodations needed.

Liability Waiver & Photo Release

I am choosing to use the facilities at South Strand Assembly of God at my own risk. I hereby release South Strand Assembly of God, it's employees, and volunteer workers from all liability for any and all damages and injuries suffered by my child(ren) while participating in events at South Strand Assembly of God.

Please select all that apply.

I, as the parent or guardian of the above registered child, have read in completion and understand this waiver.

Full Name of guardian for child

Date

I give South Strand Assembly of God permission to take and use photos and videos of the child, registered above. These photos and videos might be used on the South Strand Assembly of God’s website, social media, or in other materials to show what happened at the event and to help promote future events. I understand that I won't be paid for this.

Please select one option.

Yes, I agree No, Please do not photograph my child

Description

7/14/25 to 7/18/25 every night from 6:00-8:30pm

Please fill out this form and click submit.

VBS "Camp Chaos"

Description

Please Fix the Following