VBX 2014
Thank you so much for choosing our VBX, for your child(ren) this year.
The dates for VBX are July 14th - 18th from 9:00am to 12:00pm. VBX
is for 5th and 6th graders. We'll celebrate all the fun of being park campers-so
grab a campbag and join in on the fun. There'll be snacks, games, music, crafts
and amazing true stories lead kids to Jesus! Please consider pre-register in
your child(ren).
Cost:
The cost for VBX this year will be $18.00 per camper. If you have 3 or more in the family,
the cost will cap at $45.00 total for the family.
1. Complete and return forms which includes both pages:
a. T-shirt Page (this page) completed. See #1 below
b. Medical/Photo/Pick-up Authorization Page-completed and must be signed. See #2 below.
c. Friend Request/CD request page completed. See #3 below.
2. Check - Make payable to Bethany Baptist Church, please mark memo line of your check.
3. If mailing, this is church address: Bethany Baptist Church, 713 South Hill Park Dr.,
Puyallup, WA 98373.
Access to Internet:
Copies of the registration form can be downloaded from our website www.bethanysite.com.
Once you have completed all the forms, you may scan and e-mail or fax the completed form to
pam@bethanysite.com or fax to 253-445-4916. Followed by bringing or mailing a check to the
Church Office. Checks must be received at the office by July 13th to pre-register.
Scholarships:
Scholarship funds are available. Email Tricia Donovan, VBS Coordinator, for more information at
tricia@bethanysite.com.
1. T-Shirts: To insure we have the correct VBX t-shirt size for your child, the registration form and check must be
received at the Bethany Office by June 16, 2014. Please mark below your children sizes by placing name by the
size. Make sure this page is turned in with your registration form.
Child size: M(10-12) _______
L(14-16) _______
XL(18-20) _______
Adult size: S _______
M _______
L _______
XL _______
You can still register your child(ren) at the church after June 16th, however, T-shirt sizes will be 1st come 1st served.
2. Make sure when you fill out the registration form, that the grade for VBX is the grade that your child will enter in
the Fall 2014.
3. Friend Request - Also, available to our campers are cd’s with the VBS music recorded on them. This cd is free of
charge to all registered families. Make sure to indicate your request on the Registration Form.
4. PHOTOS – Please be advised that photos of children other than your own must not be published anywhere.
If you want photos of your children, make sure to take advantage of the photo opportunity at the end of
the program daily on the stage. We must protect the children and parents wishes to not photograph their
children. Thanks you.
Following registration, a letter will be emailed (or mailed if no email available) that outlines the process of VBX and some
instructions you will need for VBX. Please look over this letter to familiarize yourself with our VBX.
God Bless,
Pamela Nordstrom and Candy Chastagner
Church Phone: 253-848-3556
Church Fax: 253-445-4916
Staff Use Only
8:45
10:00
11:11
Reg Childcare____
Wed Childcare____
Awana__________
VBS
MOPS___________
Comm Group_____
WW Childcare____
Fuel SS___ YG___
Ignite SS___ YG___
Registration Form
Please fill all areas of the form.
1. Child’s Name:
Last
2. Child’s Name:
First
Middle
Last
First
Middle
Child’s Birth Date:
Child’s Birth Date:
mm/dd/yyyy
Age:
Grade:
Boy
Girl
Allergies or Special Needs:
____________________________________
mm/dd/yyyy
Age:
Grade:
Boy
Girl
Allergies or Special Needs:
_______________________________________
Extra Children
Parent’s or Guardian’s Name(s):
Last
First
Middle
Last
First
Middle
Address:
City:
State:
Home Phone:
(
)
Cell Phone:
(
Zip Code:
)
E-mail:
Are you willing to help in the Children’s Ministry? (yes/no)
Emergency Release Form
Emergency Contact:
Home Phone:
(
Relation to Child:
)
Cell Phone: (
)
Medical Authorizations: In the event my child(ren), named above, is injured or becomes seriously ill, and I cannot be reached,
I authorize the Nursery Coordinator, Children’s Ministry Lead and/or all program personnel to seek and authorize any and all
hospitalization, medical, dental and/or surgical treatment deemed advisable and necessary by the circumstances. I understand
that all the foregoing care will be at my expense. I have read and understand the above.
~~~~~~~~
Photo Authorizations: I give permission to Bethany Baptist Church to use any photo(s) and video(s) taken of my child(ren)
and retain a digital copy for church records.
Signature of Parent/Guardian/Other: _________________________________
Relationship to Child: ________________________________________________
Date:_________________________
Please list all persons authorized to pick up this child(ren). Only these people will be allowed to pick-up your children
unless we have written documentation and/or instructions to the contrary.
Name: ____________________________________________
Phone:(
) ___________________________
Name: ____________________________________________
Phone:(
)____________________________
Name: ____________________________________________
Phone:(
)____________________________
3. Child’s Name:
4. Child’s Name:
Last
First
Middle
Last
Child’s Birth Date:
mm/dd/yyyy
Grade:
Age:
First
Middle
Child’s Birth Date:
Age:
mm/dd/yyyy
Grade:
Boy
Girl
Allergies or Special Needs:
____________________________________
Boy
Girl
Allergies or Special Needs:
________________________________________
5. Child’s Name:
6. Child’s Name:
Last
First
Middle
Last
Child’s Birth Date:
Age:
First
Middle
Child’s Birth Date:
mm/dd/yyyy
Grade:
Age:
Boy
Girl
Allergies or Special Needs:
____________________________________
mm/dd/yyyy
Grade:
Boy
Girl
Allergies or Special Needs:
________________________________________
We will have VBS music cd’s
available starting Jun 22, 2014.
If you would like a cd please
check box below and then you
can stop by the VBS table to
pick up cd after Jun 22nd.
Free cd! But you must order it
BELOW IS FOR STAFF USE ONLY
AWANA
Official Use Only
VBX
Official Use Only
Date Paid ____________
Date Paid ________________
Cash_________________
Cash $__________________
Check # ______ $______
Check #_______ $ ________
S ____________
Receipt # _______________
Receipt # ____________
Paying for: All_______
Dues/Awards ______
Book ______
Vest/Shirt ______
T-Shirt:
Child Size: M
Adult Size: S
L XL
M L XL
Keytag: ________________