Road Trip VBC LEADER Registration Form
Thank you for signing up to be a servant leader (volunteer) at this year's VBC held
June 23-27th
! We can't wait for this road trip themed camp! Please fill out the following information.
Note:
All group leaders and station leaders must attend the leader and safety training session prior to camp. Leader training takes place the Sunday, June 22nd from 10:30am-1:30pm with lunch provided. At this training, you will help set up for the week and learn everything you need to be successful in your role during camp week.
If you cannot make that date, please email the church office, church@lakeharrietumc.org, to arrange an alternate time for training.
Leader First Name
*
Leader Last Name
*
Email Address
*
Preferred Pronouns
T-Shirt Size
*
S
M
L
XL
XXL
Birth Date
*
January
February
March
April
May
June
July
August
September
October
November
December
Sun
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Sat
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Grade Entering into Fall 2025
School Attending in Fall 2025
Please describe any special needs or allergies
*
Home church (if any)
I Would Like to Be A...
*
Group Leader
Station Leader
Greeter/Check In
Gopher (get things as needed)
Set Up Crew Only
Clean Up Crew Only
Birth Date
*
January
February
March
April
May
June
July
August
September
October
November
December
Sun
Mon
Tue
Wed
Thu
Fri
Sat
1
2
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Group Leader - Preferences for Groups
I prefer to work with ages...
*
Pre K 3 and 4
K and 1
2 and 3
4 and 5
Confirmation of Availability: As a group leader, I know I must be at camp every day, all day (Monday through Friday 9:00am-12:00pm). By clicking yes, I confirm that I am available for the whole week.
*
Yes
Parent/Guardian Information
Parent/Guardian First Name
*
Parent/Guardian Last Name
*
Parent/Guardian Email Address
*
Primary Phone Number
*
Parent/Guardian 2 First Name
Parent/Guardian 2 Last Name
Primary Home Address
*
Emergency Contact Name
*
Emergency Contact Relationship to Leader
*
Emergency Contact Phone Number
*
Are you driving yourself to camp or being dropped off/picked up?
*
Driving myself
Being dropped off/picked up
If being dropped off/picked up, please provide who and their relationship to you. Put N/A if you're driving yourself.
*
Designated pick-up's phone number (put your phone number if you're driving)
*
Insurance Policy Number
*
Name of Policy Holder
*
Permission to Administer Care: In case of an emergency, I give permission to administer necessary first aid and obtain medical care for my child(ren). In case of a surgical emergency when parents or guardians cannot be reached, I give permission to the attending physician to hospitalize and secure proper treatment for my child. By typing my name and the date (MM/DD/YY) in the box provided, I give my consent.
*
Do you agree to allow photos/videos of your child(ren) to be used in church presentation of promotional materials (print or web/social media)?
Yes to both photos and video
Yes to photos only
No
Submit