Calvary Chapel Hernando
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GIVE
2025 VBS BREAKER ROCK BEACH
VBS Registration Form
VBS Dates: June 5th - 9th 6-9PM
Child's First Name
Child's Last Name
Child's Birthdate
Last Grade Completed
Select One:
Pre-K
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
Child Gender
Select One:
Boy
Girl
Address 1
Address 2
Country
City
State
Zip/Postal Code
Parent/Guardian Email Address
Parent/Guardian Phone Number
Parent/Guardian Mobile Phone Number
Emergency Contact Name & Phone Number
Medical Concern or Food Allergies?
Select One:
Yes
No
Please Explain any conditions noted above: (Enter NONE if there are none)
Dismissal Information - Who may pick up your child at the end of each VBS day?
Does your child attend church or Sunday School, and if so, where?
Does CCH have permission to record sounds, images, or video of your child?
Select One:
Yes
No
May CCH have permission at its sole discretion, to use these sounds, images, or videos in our Church publications (including print, websites, and social media platforms)?
Select One:
Yes
No
If your child is visiting our church for VBS, who are they the guest of?
Submit Registration
