Medical Release Form
Child’s Name______________________
Phone #_______ ___________________
Pediatrics_________________________
Known Conditions______________________________
_____________________________________________
Allergies______________________________________
Additional Information __________________________
_____________________________________________
Emergency Contact (other than parent): _____________
Emergency Phone# ____________________________
In case of emergency, I hereby give my permission to the
physician selected by the VBS Director to secure proper
treatment and/or hospitalization for the above mentioned
child.
Signature of parent or legal guardian:
_____________________________________________
Date: ___________________
2017
Vacation Bible School
Student Registration Form
For Age 4 through Grade 6(completed)
Monday, July 10-Thursday, July 13
9:15 - 11:30 a.m. and
Friday, July 14 9:15 a.m.- 12 p.m.
Due to the closing program
Shady Grove Presbyterian Church
16911 Redland Rd.
Derwood, MD 20855
301-330-4326
Dear Parents,
We are looking forward to recruiting
“backpackers” for Upward Bound, our Vacation Bible
School. Upward Bound is for children age 4 through
those who have completed 6th grade. We will meet
Monday, July 11 through Thursday, July 13, from 9:1511:30 a.m. and Friday, July 14 from 9:15 a.m. – 12 p.m.
due to the closing program.
Upward Bound focuses on the story of Jesus.
During the lessons, the children will also be personally
challenged to follow Jesus.
Each morning will begin by marching into the
sanctuary for the Opening ceremony. The children will
then rotate between four stations: classroom time,
recreation, Bible Storyteller, and memory booklet
checkpoint. Please pick up your children from their
classroom at 11:30 a.m.
Pre-registration is strongly recommended as space
will be limited due to classroom size. So please register
your children and their guests ASAP. Vacation Bible
School is FREE. We will be collecting coins for a
missions project through a boy vs. girl
coin collection, but this is optional.
See you soon!
Kim Baile
for the Upward Bound Staff
As Therefore God has highly exalted him
and bestowed on him the name that is
above every name, so that at the name of Jesus every knee
should bow, in heaven and on earth and under the earth, and
every tongue confess that Jesus Christ is Lord, to the glory of
God the Father.” Philippians 2:9-11
Upward Bound
Registration Form
(One form per child)
Child’s Name _________________________________
Birthdate ___________________________
Grade Child Just Completed (if applicable)
Age _____________
Circle: Male or Female
Address _____________________________
City _________________________
State __________ Zip _________
Home # __________________________
Cell # ____________________
Siblings Attending VBS___________________
______________________________________________
Parents Interested in: Assisting with VBS? Yes_ _No___
Interested in Parent’s Bible Study from 10-11:30 a.m.?
Yes_____ No_____
*Childcare is available for infant through preschool
children, for parents volunteering with VBS.
Attend church regularly?
Yes_____ No_____
Where? ________SGPCA_________
If not a member of Shady Grove, who invited
you?__________________________________________
Please put the completed form in the box on the wall
to the left of Sign-up Central or mail it to the church
office at:
Shady Grove Presbyterian Church
16911 Redland Rd., Derwood, MD 20855