Breakthrough

Camp Out VBS Registration

Please fill out the form below for each child participating. After submitting this form, please follow the link below for payment. 

Child's Name *
Child's Name
Birthdate *
Birthdate
Parent/Guardian Name *
Parent/Guardian Name
Address *
Address
Home Phone *
Home Phone
Cell Phone/Mother
Cell Phone/Mother
Cell Phone/Father
Cell Phone/Father
Emergency Contact *
Emergency Contact
To be notified if parents cannot be reached.
Emergency Contact Phone *
Emergency Contact Phone
Enrollment Consent
I give permission for my child to be treated in the event of an emergency and authorize the leadership of First Baptist Wheaton to act in my behalf in this matter. I consent to have my child's photograph taken while he/she is participating in activities at VBS. Pictures will not be given out to other groups. (For website permission, see below.) I give consent to enroll my child in Breakthrough Summer Camp (June 26 - July 28, Monday - Friday 9:00am - 1:00pm; no school July 3, 4).
Release to use Photographic Images on Web or Print Publications
The undersigned consents to have photographs taken of my child during VBS to be used on the First Baptist Wheaton Website and/or in VBS promotional material. No names will be used.