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VBS REGISTRATION: Mount Everest

 

Rossford United Methodist Church

July 20-23, 2015                      5:15-8:30 pm.

 

Child's name________________________________________________________________________

Parent/Guardian Name: _______________________________________________________________

Address: ___________________________________________________________________________

____________________________________________________________________________________

Email Address: ______________________________________________________________________

Phone Number (Home)___________   (Cell) _____________   (Work) _____________

Age Information

    Date of Birth: ________________   Age: ______________

    Last school grade completed: _______________________

Home Church: ________________________________________________________________________

Allergies/Medical Information/Other:

_____________________________________________________________________________________

_____________________________________________________________________________________

Emergency contacts:

     Name: ________________________________________     Phone: ______________________

     Name: ________________________________________     Phone: ______________________

Dismissal information: (Names of persons who may pick up this child from VBS

________________________________________________________________________________________