2018 LCC Vacation Bible School Registration

August 7-11, 2018 | Please complete this form, using one form per family, and click submit.

If you have any questions, please contact LeeAnn Steenhoek, Director of Christian Education. Email familyministry@lymecongregationalchurch.org, or call (603) 864-9005. You may also call the Lyme Congregational Church office, Tuesday through Thursday mornings, at (603) 795-2850.

Warning!

This form cannot be submitted until an administrator completes the setup process to receive online payments.

Participant Information

Please complete information for each participating child. If you intend to register more than three children, please submit an additional form.

Child 1

Child 1 Birth Date

Child 1 Allergies or other special need(s)

Child 2

Child 2 Birth Date

Child 2 Allergies or other special need(s)

Child 3

Child 3 Birth Date

Child 3 Allergies or other special need(s)

Home Address

Parent/Guardian Information

Primary Contact Name

Primary Contact Email

This address will receive a confirmation email

Primary Contact Preferred Phone

Preferred Phone Type

Please select all that apply.

Home Mobile Work

Primary Contact Other Phone

Other Phone Type

Please select all that apply.

Home Mobile Work

Names of other adults who may drop off or pick up your child(ren)

Emergency Contact Information

Emergency Contact 1

Emergency Contact 1 Phone

Emergency Contact 2

Emergency Contact 2 Phone

Would You Like to Help?

I would be willing to help with

Please select all that apply.

Snacks during the program Activities during the program Rides Counselor lunches Counselor afternoon or evening activities Other LCC Child and Youth activities

There is no fee for Vacation Bible School! We gratefully accept donations to help cover the costs of the program.

Donation

($0) Cost of one child ($75) Other

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

August 7-11, 2018

Please complete this form, using one form per family, and click submit.

If you have any questions, please contact LeeAnn Steenhoek, Director of Christian Education. Email familyministry@lymecongregationalchurch.org, or call (603) 864-9005. You may also call the Lyme Congregational Church office, Tuesday through Thursday mornings, at (603) 795-2850.

2018 LCC Vacation Bible School Registration

Description

Please Fix the Following