VBS Registration – Pine Valley Church

This year, Pine Valley will be taking your children out of this world to teach them to Shine Jesus’ Light in all situations. Join us as we help your child(ren) learn and accept God’s love and compassion through fun and excitement, stories and crafts, and all around enjoyment for ages 4 – 12. Please submit your registration form as soon as possible so that we can make sure there is enough food for your child as this year we will be providing dinner with our VBS. We are so excited to be taking your child(ren) into STELLAR!!!

Theme: Stellar: Shine Jesus Light

Church Address: 910 Pine Valley Rd, Jacksonville, NC 28546

Date: August 14th – 18th

Time: 5:30 PM – 8:00 PM

Ages: 4- 12

Child's Name

Child's Age

Parent/Guardian Name

Parent/Guardian Phone Number

Home Address

Email Address

Prefered Contact Method

Emergency Contact #1

Emergency Contact #2

Allergies, Special Needs, Dietary Restrictions, or Medical Concerns

Who may pick up your child at the end of each VBS day?

Include any additional information you would like us to know.

I grant Pine Valley United Methodist Church, and employees, the right to take photos of me or my child for use within the context of Vacation Bible School's "recaps" at the end of each day during VBS week.

I grant Pine Valley United Methodist Church, its representatives, and employees the right to take photos of me or my child for use beyond the context of Vacation Bible School, for any lawful purpose, including such purposes as publicity, illustration, advertising, and Web content for the church.

I grant Pine Valley United Methodist Church, its representatives, and employees the right to publish my or my child's name in any associated publicity if required.

I have read and understood the above.

Pine Valley United Methodist Church, its representatives, and employees will not use the images taken, or any other information you provide, for any other purposes than those listed in this form. If you have any questions or concern, please call us at (910) 353-4611 or email us at pinevalleyumcjax@gmail.com.