VBS - MONTEZUMA UNITED METHODIST CHURCH

VBS 2019 Online Registration

* Indicates required field

Child's Name (one form per child please) *

First

Last

Grade Entering (fall 2018) *

Birth Date *

Age *

Parent's Name(s) *

First

Last

Name *

First

Last

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Home Phone Number *

Alternative Phone Number *

Emergency Contact Person *

First

Last

Relationship to Student *

Home Phone Number *

Alternate Phone Number *

Food Allergies *

If yes, please list *

Medical Concerns *

Family Doctor *

First

Last

Doctor's Phone Number *

If yes, explain *

Sibling(s) Attending VBS (Names and Ages)

Name *

First

Last

Age *

Name *

First

Last

Age *

Name *

First

Last

Age *

Name *

First

Last

Age *

Name *

First

Last

Age *

Name *

First

Last

Age *

Name *

First

Last

Age *

Church Affiliation *

Church Membership At *

Person(s) Name(s) Who May Pick up the Child *

First

Last

Phone Number *

Person(s) Name(s) Who May Pick up Child *

First

Last

Phone Number *

Vacation Bible School (VBS) leaders have permission to photograph/ film the minor(s) designated above for any lawful purpose associated with this VBS program.

Electronic Signature *

Submit

VBS 2019 Online Registration

2016 VBS Photos

We Would Love to Have You Visit Soon!

Hours

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Email

Address