2880 California Avenue
Corona, CA 92881
(951) 737-5225
​Office Hours:
M-Th 8:30am-1:30pm
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Register a Child For VBS Mini Camp 2022
Enter the information below to register your child for our upcoming VBS program. Please complete this form for every additional child also. If you have any issues registering please contact Loni Cuatt at
[email protected]
*
Indicates required field
Name of Child
*
First
Last
Gender
*
Male
Female
Birth Date
*
Minimum age is 3 years old by June 30, 2018 and potty trained.
Child's T-Shirt Size
*
T3
T3
T4
T5
Child XS
Child S
Child M
Child L
Child XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Grade (Fall 2022)
*
3yr old (must be potty trained)
4yr old
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
Teen Helper
Minimum age is 3 years old by June 30, 2018 and potty trained.
Parent/Guardian's Name
*
First
Last
Phone Number
*
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Emergency Contact
if parents cannot be reached
(friend, relative, neighbor)
Name
*
First
Last
Phone Number
*
Allergies/Special Needs
Does your child have any allergies or medical issues we need to be aware of? (If so, please inform us here)
*
Will the child be bringing an EpiPen with them to VBS?
*
Yes
No
Is there something unique you would like to share about your child that would assist us in making this experience a great one? (Health concerns, special needs such as sensory concerns, ADHD, Autism, Asperger’s, Down Syndrome, etc)
*
Medical
I, the undersigned, hereby authorize a representative of Corona United Methodist Church to consent to and authorize emergency medical treatment, surgery or dental care to be given to my son/daughter as considered advisable or necessary in the judgement of an emergency medical professional or attending physician.
Please type your name indicating your consent
*
Permission
The registrant has my permission to participate in Corona United Methodist Church VBS 2022. I understand when participating in VBS activities, the registrant may be photographed for print, video, or electronic imaging. I understand the images may be used in promotional materials for Corona United Methodist Church. I acknowledge the images will be the sole property of Corona United Methodist Church.
Please type your name indicating your consent
*
Registration Fees
(check all that apply)
You may pay it online using Zelle or bring a check to the church office ahead of time or on the 1st day of VBS. Please note the VBS
fee
is non refundable.
Please select one
*
I will pay the $30 registration fee (primary child) online
I will pay the $20 sibling/friend registration fee online
I will pay my registration fees in person by cash or check
I am interested in a scholarship
Submit