Please complete the following form in order to register your child(ren) (age 4 through 5th grade) for Pathway Community Church's VBS 2012. Once you have completed the form, please click the "submit" button at the bottom of the form.

Please Note: If you have more than four children that will be attending or if you have children that have different addresses, please complete the form an additional time to provide us with the additional information. (Please note, if you use your browser's "back" button after submitting the initial form, it should save all the previously entered information for you so you will only need to update the info for any additional children.) Thanks!

Does your family attend a church?
YES    NO    If yes, where?

How did you hear about this event?


PARENTAL RELEASE: I authorize my child(ren) to attend Pathway Community Church's Backyard VBS 2012. In the event of an emergency, I understand that all will be done to contact me. However, if I cannot be reached, I give permission to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child(ren). Therefore, I release Pathway Community Church and their agents or employees from any claim I may have as a result of my child(ren) being injured. I also understand and accept that my child(ren) may be photographed or video taped during VBS 2012 for presentations or promotional use.

YES, I accept the terms and conditions above.