Vacation Bible Camp Child Registration
Monday-Thursday, June 12-15, 6:30-8 p.m. (dinner at 5:30 p.m.)
Camp for ages 3 through 5th grade. Register each child individually. Parent(s) are welcome to attend with their children, but it is not required. If parent is not in attendance, child must be potty trained. Nursery for volunteer children available. Suggested donation of $10 for first child (maximum $30 per family). Please contact Lisa Dominy (lisa@vrumc.org) with questions.
Child's name
Your answer
Date of birth
MM
/
DD
/
YYYY
Grade in fall 2017
Gender
Allergies or other concerns (indicate NONE, if none)
Your answer
T-shirt size
Parent/guardian name
Your answer
Address
Your answer
City
Your answer
State
Your answer
ZIP
Your answer
Phone
Your answer
Email
Your answer
Please indicate the night(s) your child will have dinner with us.
I/we plan to attend with my child?
I want to purchase an adult VBC T-shirt (cost $10 each).
T-shirt size
Is there a friend your child wants to be placed with?
If YES, please list name of friend.
Your answer
Do you prefer that your children be placed together?
Are you currently a member of a church family?
If YES, where?
Your answer
Would you like information about this church?
How did you find out about VBC at VRUMC?
Emergency contact
Your answer
Phone
Your answer
Physician's name
Your answer
Phone
Your answer
Person responsible for picking up my child from VBC, if different from parent.
Your answer
Phone
Your answer
I give my permission for VRUMC to seek emergency medical care in the event that I cannot be reached. I release Vista Ridge United Methodist Church, its staff and volunteers of any liability in the event of accident or injury. VRUMC occasionally uses photography/video for publicity purposes. I give my permission to photograph/film my children for possible inclusion in VRUMC publications, website and other publicity materials.
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