Federated Church - East Springfield, PA.

Parent or Guardian's Info

First Name

Last Name

Email

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Text

Yes

No

Emergency Contact

First Name

Phone Number

Text

Yes

No

Approved to Pickup

First Name

Last Name

Phone Number

Text

Yes

No

First Name

Last Name

Phone Number

Text

Yes

No

Child Info

First Name

Last Name

Gender

Birth Date

Allergies

If your child is going into 3rd- 5th Grade, they will be participating in a cross-training skill during VBS.

Please indicate child’s first choice:

Add another Child?

Yes

No

Child #2

First Name

Last Name

Gender

Birthdate

Allergies

If your child is going into 3rd- 5th Grade, they will be participating in a cross-training skill during VBS.

Please indicate child’s first choice:

Add another Child?

Yes

No

Child #3

First Name

Last Name

Gender

Birthdate

Allergies

If your child is going into 3rd- 5th Grade, they will be participating in a cross-training skill during VBS.

Please indicate child’s first choice:

Add another Child?

Yes

No

Child #4

First Name

Last Name

Gender

Birthdate

Allergies

If your child is going into 3rd- 5th Grade, they will be participating in a cross-training skill during VBS.

Please indicate child’s first choice:

Add another Child?

Yes

No

Child #5

First Name

Last Name

Gender

Birthdate

Allergies

If your child is going into 3rd- 5th Grade, they will be participating in a cross-training skill during VBS.

Please indicate child’s first choice:

Add another Child?

Yes

No

Child #6

First Name

Last Name

Gender

Birthdate

Allergies

If your child is going into 3rd- 5th Grade, they will be participating in a cross-training skill during VBS.

Please indicate child’s first choice:

NOTE: Space in activities is limited and every effort will be made to honor this choice on a first-come, first-served basis.

Liability Agreement and Parental Consent

I consent for my child (or children) listed in this registration to participate in TRUE NORTH VBS at the Federated Church during the week of July 21 – July 25, 2025. Every activity at VBS is carefully planned and supervised, however, unforeseen events and even injuries may occur. By registering my child for TRUE NORTH VBS, I agree to assume and accept all risks and hazards during TRUE NORTH VBS and it’s related activities. I also agree not to hold Federated Church, church staff, nor any VBS volunteers liable for any incidental/accidental injuries experienced as a result of their participation in VBS. In the event that I cannot be reached in an emergency, I hereby grant permission to the physician and facility selected by the Federated VBS program leadership to secure appropriate treatment for my child. Insurance is considered to be the personal responsibility of the program participant.

Insurance Co.

Agreement #

Group #

Family Physician

I understand that VBS activities are often photographed/recorded for publication and public relations and I grant permission to Federated Church and the TRUE NORTH VBS leaders to use photos/videos of my child for these purposes.

Single Choice

Yes

No

Signature

Date of Signature

True North Registration

True North is this summer’s Vacation Bible School adventure at the Federated Church!

Parent or Guardian's Info

Emergency Contact

Approved to Pickup

Child Info

Child #2

Child #3

Child #4

Child #5

Child #6

Liability Agreement and Parental Consent

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