2017 VBS Registration

Please note: 5th-8th Graders will be transported to and from our sister church Faith UMC, 795 W. Madison Street by adult chaperones.

* Indicates required field

Name *

First

Last

Grade going into. *

T-Shirt Size *

Age *

Birthday *

Parent/Guardian Name *

Home Address *

City and zip code *

Home Phone *

Emergency contact person *

Cell Phone *

Emergency contact phone number *

Home Church *

Email Address *

Allergies or other medical conditions (this will be listed on their name tags) *

Alternate People that are allowed to pick up your child *

5th-8th grade ONLY. My child does need signed out at the end of the day *

Yes No

I agree to receiving marketing and promotional materials

Submit