{"id":291,"date":"2019-06-10T16:04:06","date_gmt":"2019-06-10T16:04:06","guid":{"rendered":"http:\/\/clarkscornerscommunitychurch.org\/?page_id=291"},"modified":"2025-05-11T20:22:37","modified_gmt":"2025-05-11T20:22:37","slug":"vbs-registration-form","status":"publish","type":"page","link":"https:\/\/clarkscornerscommunitychurch.org\/index.php\/vbs-registration-form\/","title":{"rendered":"VBS Registration Form"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-38ff5078-cbb6-41fc-9550-9705211e98e2\" id=\"wpforms-1142\"><form id=\"wpforms-form-1142\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1142\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/291\" data-token=\"99c91eff52b7050abf21b68af76badb3\" data-token-time=\"1777579847\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-1142-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_1\">Child&#039;s Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" required><\/div><div id=\"wpforms-1142-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_2\">Street Address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required><\/div><div id=\"wpforms-1142-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_3\">City <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_3\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][3]\" required><\/div><div id=\"wpforms-1142-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_4\">State <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_4\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-1142-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_5\">Zip Code <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_5\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][5]\" required><\/div><div id=\"wpforms-1142-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_6\">Home Phone Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_6\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][6]\" required><\/div><div id=\"wpforms-1142-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_7\">Cell Phone Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_7\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][7]\" required><\/div><div id=\"wpforms-1142-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_8\">Home Email Address<\/label><input type=\"text\" id=\"wpforms-1142-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" ><\/div><div id=\"wpforms-1142-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_9\">Child&#039;s Date Of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_9\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][9]\" required><\/div><div id=\"wpforms-1142-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_10\">Child&#039;s School Grade completed June, 2024 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_10\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][10]\" required><\/div><div id=\"wpforms-1142-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_11\">Emergency Contact Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" required><\/div><div id=\"wpforms-1142-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_12\">Emergency Contact relationship to child <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_12\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][12]\" required><\/div><div id=\"wpforms-1142-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_13\">Emergency Contact Phone Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_13\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][13]\" required><\/div><div id=\"wpforms-1142-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_14\">Child&#039;s Mother&#039;s Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" required><\/div><div id=\"wpforms-1142-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_15\">Child&#039;s Father&#039;s Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" required><\/div><div id=\"wpforms-1142-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_16\">Child&#039;s Allergies <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" required><\/div><div id=\"wpforms-1142-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_17\">Child&#039;s Medical Concerns <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_17\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][17]\" required><\/div><div id=\"wpforms-1142-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_18\">Child&#039;s Home Church<\/label><input type=\"text\" id=\"wpforms-1142-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" ><\/div><div id=\"wpforms-1142-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_19\">Invited to VBS by:<\/label><input type=\"text\" id=\"wpforms-1142-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" ><\/div><div id=\"wpforms-1142-field_20-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_20\">Child will be dismissed to:  (If different on any night or if child is to leave earlier than dismissal time, written permission must be submitted) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1142-field_20\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][20]\" required><\/div><div id=\"wpforms-1142-field_22-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-1142-field_22\">Permission for child&#039;s picture to be taken and possibly shown on social media? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1142-field_22\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][22]\" required=\"required\"><option value=\"Yes\"  class=\"choice-4 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-2 depth-1\"  >No<\/option><\/select><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1142\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/clarkscornerscommunitychurch.org\/index.php\/wp-json\/wp\/v2\/pages\/291\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1142\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/clarkscornerscommunitychurch.org\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":1811,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["entry","page","publish","author-grove00","post-291","has-post-thumbnail"],"_links":{"self":[{"href":"https:\/\/clarkscornerscommunitychurch.org\/index.php\/wp-json\/wp\/v2\/pages\/291","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/clarkscornerscommunitychurch.org\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/clarkscornerscommunitychurch.org\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/clarkscornerscommunitychurch.org\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/clarkscornerscommunitychurch.org\/index.php\/wp-json\/wp\/v2\/comments?post=291"}],"version-history":[{"count":14,"href":"https:\/\/clarkscornerscommunitychurch.org\/index.php\/wp-json\/wp\/v2\/pages\/291\/revisions"}],"predecessor-version":[{"id":1812,"href":"https:\/\/clarkscornerscommunitychurch.org\/index.php\/wp-json\/wp\/v2\/pages\/291\/revisions\/1812"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/clarkscornerscommunitychurch.org\/index.php\/wp-json\/wp\/v2\/media\/1811"}],"wp:attachment":[{"href":"https:\/\/clarkscornerscommunitychurch.org\/index.php\/wp-json\/wp\/v2\/media?parent=291"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}