Vacation Bible School Registration — St. Andrew's Redondo Beach

VBS is open to kids, ages 4 years old to those going into 5th grade in the fall. Space will be limited to 60 students. The cost is $45 per student. A snack and bottled water will be provided.

Please answer each question and click SUBMIT to complete your registration. You'll be promptly redirected to the payment page, which will allow you to pay online with a credit card or bank transfer. If you wish to pay by check or cash, please drop off your payment with Richelle De Aragon on Sunday. If you have any questions, please email rdearagon@sntandrew.org.

CHILD INFORMATION

Child's Name

First Name

Last Name

Grade in September

** PLEASE NOTE: PRE-SCHOOL SECTION IS FILLED **

Birth Date

YYYY

Second Child's Name (if applicable)

Grade in September

Birth Date

YYYY

Third Child's Name (if applicable)

First Name

Last Name

Grade in September

Birth Date

YYYY

Fourth Child's Name (if applicable)

First Name

Last Name

Grade in September

Birth Date

YYYY

PARENT INFORMATION

Parent's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Email Address

AUTHORIZATIONS & ADDITIONAL CONTACTS

Adult authorized to pick up my child(ren):

Authorized Person Phone

(###)

###

####

Second Adult authorized to pick up my child(ren):

Second Authorized Person Phone

(###)

###

####

Person to Contact in Case of Emergency

Emergency Contact Phone

(###)

###

####

Doctor's Name

Doctor's Phone

(###)

###

####

Allergies or health concerns we should be aware of:

Publicity Release

I authorize St. Andrew’s Redondo Beach to capture and use pictures of my child(ren) for promotional purposes including website, print, social media, and other publicity formats as needed. I understand that names of underage children will be omitted, and I have the right to contact the church and ask that a picture be removed for privacy reasons.

Authorize

Opt out

Total Amount Due

Fill out the amount you'll be paying based on the number of children you are registering. After clicking SUBMIT, a payment page will appear. Please note: registration is not considered complete until payment has been received.