To Mars and Beyond VBS 2019 To Mars and Beyond Registration form for Peoples Presbyterian Church Vacation Bible School ⎯ July 15 - 19, from 6:00-8:00 pm. It is FREE to attend and available to ages 4 through 6th grade. If you are registering more than 3 children, please fill out and submit an additional form. Please contact Laura in the church office with any questions: [email protected] RegistrationParent(s) Name(s):* First Last First Last Parent Email*Cell Phone:*Home Phone:Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Child InformationChild's Name* First Last Child's birthdate*Grade in the fall:*Allergies or other medical conditions (if none, write NA):*If registering more than one child, please write each child's name and their allergies/medical conditions. (e.g. Sarah-allergic to peanuts, asthma. Matt-NA.)Second Child's Name First Last Second Child's birthdateSecond Child's grade in the fallAllergies or other medical conditions (if none, write NA):If registering more than one child, please write each child's name and their allergies/medical conditions. (e.g. Sarah-allergic to peanuts, asthma. Matt-NA.)Third Child's Name First Last Third Child's birthdateThird Child's grade in the fallAllergies or other medical conditions (if none, write NA):If registering more than one child, please write each child's name and their allergies/medical conditions. (e.g. Sarah-allergic to peanuts, asthma. Matt-NA.)Emergency contact name and phone (if parent is unavailable):*Permission is given to Peoples Presbyterian Church to obtain emergency medical treatment in the event of an accident or injury:* Yes No Permission to use child's photograph in church/social media/public use:* Yes No We take photographs throughout VBS of the children and activities. We may or may not use these photographs on our website, church directory, Facebook page, Instagram page, Twitter page, local paper, etc. Home church name (if other than Peoples):Are you looking for a church? Yes No First time attending? Yes No How did you hear about our Vacation Bible School?*T-shirt size:*Youth 2-4Youth 6-8Youth 10-12Youth 14-16Youth 18-20Men's - smallMen's - mediumMen's - largeMen's - XLFor additional t-shirts / Notes:If registering more than one child, please note each child's name and t-shirt size above. Thank you! Also, if there is anything else we should know, or any comment you'd like to add - please do so here.