SVAC VBS 2025 Registration

Dates: July 21st (Monday) to July 25th (Friday)
Time: 9:30am to 12:30pm
Location: Silicon Valley Alliance Church 10 Dempsey Road, Milpitas, CA 95035

Age: 3 yrs old to completion of 5th Grade
(All children must be fully potty-trained and 3 years old or older by 7/20/2025.)

Registration Fee: $60/child or $110/family*
* 2 or more siblings from his/her own immediate family only

All payment is non-refundable. We accept PayPal.

PLEASE USE CHROME, FIREFOX, MICROSOFT EDGE TO FILL OUT THIS APPLICATION


Child(ren)'s Information

Number of Child(ren) Registering:

Information of Child 1

Name of Child 1:*
Gender of Child 1:*
Birth Year of Child 1:*
Birth Month of Child 1:*
Current Grade of Child 1:*
T-shirt Size of Child 1:*
Please list any medical concern, diet restriction and instructions for the staff of Child 1: (If there is none, please type "None")

Information of Child 2

Name of Child 2:*
Gender of Child 2:*
Birth Year of Child 2:*
Birth Month of Child 2:*
Current Grade of Child 2:*
T-shirt Size of Child 2:*
Please list any medical concern, diet restriction and instructions for the staff of Child 2: (If there is none, please type "None")

Information of Child 3

Name of Child 3:*
Gender of Child 3:*
Birth Year of Child 3:*
Birth Month of Child 3:*
Current Grade of Child 3:*
T-shirt Size of Child 3:*
Please list any medical concern, diet restriction and instructions for the staff of Child 3: (If there is none, please type "None")

Information of Child 4

Name of Child 4:*
Gender of Child 4:*
Birth Year of Child 4:*
Birth Month of Child 4:*
Current Grade of Child 4:*
T-shirt Size of Child 4:*
Please list any medical concern, diet restriction and instructions for the staff of Child 4: (If there is none, please type "None")*

Parents' Information

Parent's/Guardian's Name:*
Relationship:*
Address:*
Phone Number:*
-
E-mail:*
Attending church regularly?:*
Home Church:
How did you hear from us?*

Emergency Contact's Information

Emergency Contact's Name:*
Emergency Contact's Phone:*
-
Emergency Contact's Email:*

Release of Liability

I, the undersigned, parents of:*

do agree to release and hold Silicon Valley Alliance Church (SVAC) and its staff and volunteers harmless from any claim, demand or cause of action for injury to the above named participant(s) of SVAC’s VBS program or damage to his or her personal property which arises out of or is in any way connected with the programs of SVAC. SVAC will not be responsible in case of accident, illness or property damage. I also authorize SVAC to put my child under the treatment when my child is in medical need. I also agree that my child(men) be treated by any licensed physician. I also understand SVAC may photograph or videotape the events or activities in which I am (or my child is) participating. I give my permission for SVAC to use photographs or videotape of me (or my child) for the purpose of promoting its services/programs. I give my permission with the following understanding: No compensation of any kind will be paid to me (or my child) at the time or in the future for the use of my (or my child’s) likeness, i.e. your child's name on the video.

I agree to the terms of the release of liability*
Please type your name below as the signature*
Today's Date:*

Click SUBMIT button below to pay the registration fee via PayPal

Click "Submit" button and you will be redirected to the PayPal website to submit your payment. An email will be sent to you to confirm your registration.

Silicon Valley Alliance Church is committed to protecting your privacy and does not share your personal information with third parties. For further information, see Silicon Valley Alliance Church Privacy Policy.

Amount for One Child:
 $ 
Amount for Family:
 $ 


Copyright © 2022 Silicon Valley Alliance Church. All Rights Reserved.