VBS Registration

Please fill out form.

CHILD'S NAME:

DATE OF BIRTH:

ADDRESS:

CITY:

HOME PHONE:

CELL PHONE:

PARENT/GUARDIAN:

AGE OR GRADE GOING ONTO:

HOME CHURCH (IF ANY):

IN CASE OF EMERGENCY:

PHONE:

CHILD'S DOCTOR:

ALLERGIES? IS SO, WHAT ARE THEY?

My child, listed above, has my permission to participate in the Vacation Bible School program at the First United Methodist Church of St. Marys, PA the week of July 10-14.

While we strive to ensure a wholesome, safe and closely supervised environment for the children in its care, The First United Methodist Church and its volunteers cannot be held liable and I will not hold them liable for any unforeseeable accidents or injuries which may occur during the course of Vacation Bible School.

In the event of an emergency, if I cannot be reached, I give my permission for my child to receive emergency treatment at any hospital or emergency care center.

PARENT/GUARDIAN signature:

Date: