Vacation Bible eXperience

You’re invited to the ultimate pep rally!

Dates: Monday, June 23rd – Thursday, June 26th

Times: 6 – 8:30 PM

Ages: Pre-K going into Kindergarten – 5th grade

Fee: FREE!

But thanks be to God, who gives us the victory through our Lord Jesus Christ. 1 Corinthians 15:57

Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Grade Completed*
Age
Parent Name*
First Last
Parent Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Siblings attending VBX.
Allergies [We require an Action Plan for any allergy listed. Medication may be required.]
Special Needs [We require a Care Plan for children with special needs.]
Authorized Pick-Up #2[Picture ID's may be requested.]
Pick-Up #2 Phone Number
Pick-Up #2 Relationship to Child
Waiver for Medical Treatment*
Giving consent provides Highpoint staff permission to use any necessary medical treatment for my child during the course of this event.
- Yes – I give consent
- No – I DO NOT give consent
Waiver for Photo/Video Release*
Giving consent provides Highpoint permission to use any photos or videos taken of my child involved in Highpoint programs to be used for promotion, training, or display.
- Yes – I give consent
- No – I DO NOT give consent
Parent Signature