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Pleasantville EVBS
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EVBS Registration 2022
Parent / Guardian Information
Primary Parent Contact Name
*
First
Last
Primary Email
*
Secondary Email
Primary Daytime Phone
*
Phone Type
*
Mobile
Home Landline
Work Phone
EVBS is allowed to send me text messages.
Secondary Phone
Secondary Phone Type
Mobile
Home Landline
Work Phone
EVBS is allowed to send me text messages.
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
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Algeria
American Samoa
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Angola
Anguilla
Antarctica
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Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
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El Salvador
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Eritrea
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Eswatini
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Falkland Islands
Faroe Islands
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Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
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Guadeloupe
Guam
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Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
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Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
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Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
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Mali
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Mongolia
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Montserrat
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Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
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Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
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South Georgia and the South Sandwich Islands
South Sudan
Spain
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Sudan
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Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
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Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Church Affiliation
*
Holy Innocents Parish
Pleasantville Presbyterian Church
Emanuel Evangelical Lutheran Church
St. John's Episcopal Church
Holy Rosary Parish
Other - We're New!
Child Registration
Register Students
Child Name
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Children.
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Maximum number of children reached.
Emergency Contact Information
Emergency Contact Name
*
First
Last
Emergency Contact Relationship
Emergency Contact Phone
*
Physician Name
*
Physician Phone
*
Registration Fee
Consent
*
By checking the box below you are giving permission for your child(ren) to participate in Pleasantville's Ecumenical Vacation Bible School (EVBS) and you understand and accept all risks to participating in the planned activities.
Pleasantville EVBS may take pictures or videos of your child during the course of the program. These photos will be shared in the Thursday evening program and may be used for promotional purposes in the future.
I agree
Hidden
Number of Kids
Registration Fee
Price:
$35.00
Registration Fee
Price:
$35.00
Registration Fee
Price:
$35.00
Hidden
Registration Cost
Hidden
Registration Cost
Hidden
Registration Cost
Credit Card
Cardholder Name
Card Details
We need volunteers!
I can volunteer the whole week
I can volunteer Monday morning
I can volunteer Thursday evening
Adult and high school volunteers are needed to teach, supervise, run outdoor games, prepare daily snacks, set-up, clean-up and more.
Email
This field is for validation purposes and should be left unchanged.
Child Name
*
First
Last
Birthdate
*
Month
1
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Day
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Year
2024
2023
2022
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2020
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2016
2015
2014
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2012
2011
2010
2009
2008
2007
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1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Grade in Sept '22
*
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
T-Shirt Size
*
XS
Small
Medium
Large
XL
2XL
3XL
T-Shirt Size
*
Note: No t-shirt guaranteed after 7/25/2022
Youth Sized
Adult Sized
Allergies?
*
Youth Group Participants
Youth Group (6-8th grade) parents please check the box below to indicate permission for your child to walk with the group to some of the other churches and to participate in our mission projects.
I understand and agree.
Hidden
Parent / Guardian Name
First
Last
Hidden
Primary Contact Phone
Hidden
Primary Contact Email
Hidden
Church Affiliation
Hidden
Pediatrician Name
Hidden
Pediatrician Phone
Hidden
Emergency Contact Name
First
Last
Hidden
Emergency Contact Phone
Hidden
Church Affiliation
St. John's Episcopal Church
Pleasantville Presbyterian Church
Holy Rosary Parish
Holy Innocents Parish
Emanuel Evangelical Lutheran Church
The United Methodist Church in Pleasantville
Other - We're New!