VBS Registration Form: Day & Evening

Vacation Bible School Registration Form 

Please register this child for:  (check one or both VBS programs)

 GOD'S BIG BACKYARD

Evening Vacation Bible School: June 22 – June 26, 2008   6:30 to 8:30 p.m.

  BEACH PARTY

Daytime Vacation Bible School: August 11 - 15, 2008   9 a.m. to noon

Child’s First Name:  Child’s Last Name:

Address:

Date of Birth (xx/xx/xxxx):   Current Age: Please select age...1 year old2 years old3 years old4 years old5 years old6 years old7 years old8 years old9 years old10 years old11 years old12 years old

2007-08 School Grade:  Please select grade...Pre-3Pre-4Pre-KKindergarten1st grade2nd grade3rd grade4th grade5th grade6th grade

Parent/Guardian Name:

Daytime Phone/Cell Phone:

Parent/Guardian Name:

Daytime Phone/Cell Phone:

Parent Email Address:

Home Church:

List name of persons who may pick up this child from VBS:

Allergies or Medical Conditions:

Medical Insurance:  Yes         No

Insurance Company:

Policy Group ID#:  

Primary Care Physician: Phone:

Emergency Phone #’s if Parent/Guardian cannot be reached:

Name:  Phone:

Name:  Phone:

I give my permission for Aldersgate UMC to seek emergency care if needed for

my child during the hours of Vacation Bible School: Yes       No

Name (Parent or Guardian indicating permission)                                      Date: