5 yr old Preschool VBS Registration

July 8 -11: 9:15-12:15 | Please fill out this form and click submit to register your child for VBS. One form must be completed per child. VBS is from 9:15-12:15. There is no charge for VBS, but donations are accepted; we estimate the cost for each child is $35.

Participant's Info:

This sections is about your child:

Name

Birthdate

Gender

Please select one option.

Male Female

Address

Tshirt Size

Please select one option.

Youth XS Youth S Youth M Youth L

Crew mate request:

Medical Info

Family Physician

Physician Phone

Family Insurance Company

Policy #

Allergies or Special Needs?

Please select all that apply.

Yes No

If yes, please explain:

Do you have any of these conditions?

Please select all that apply.

Asthma Kidney Trouble Heart Trouble Diabetes

Current medications you are taking. (Please ist)

Parent / Guardian Info:

Guardian 1:

First Name

Last Name

Phone

This address will receive a confirmation email

Relationship to participant

Guardian 2:

First Name

Last Name

Phone

Relationship to participant

Alternate Pickup (required)

First Name

Last Name

Phone Number

Relationship to camper:

Permission to Treat

My permission is granted for the Montgomery United Methodist Church, Children’s Director, Church official or any other volunteer in charge to obtain necessary medical attention in case of sickness or injury to my child.

By typing my name, I grant permission to seek treatment for my child

Photo/Video Release

Also, I understand that as a participant, my child may be photographed or videotaped during normal church activities and these photos/ videos may be used in promotional materials.

By typing my name in this box, I give permission for my child to be photgraphed/videoed.

Description

July 8 -11: 9:15-12:15

Please fill out this form and click submit to register your child for VBS. One form must be completed per child. VBS is from 9:15-12:15. There is no charge for VBS, but donations are accepted; we estimate the cost for each child is $35.

5 yr old Preschool VBS Registration

Description

Please Fix the Following