To Mars and Beyond! FUMC VBS 2019
Registration Form for Vacation Bible School (VBS)
July 14-18, 2019 at First United Methodist Church Lockhart, Texas
Dinner for Families 5:30-6 VBS Program 6-8:00 Adult Bible Study 6:30-8

For Children who JUST COMPLETED grades Pre-K thru 5 (or, in other words:
are GOING INTO grades K thru 6)

PLEASE COMPLETE THIS FORM FOR EACH CHILD YOU ARE REGISTERING.
(auto-fill should speed up completion after the first one :-)

313 W. San Antonio St. P. O. Box 897 Lockhart, Texas 78644
https://firstmethodistlockhart.org Telephone: 512-398-3232 Fax: 512-398-4421

*In case you do not have all the info at this time, you can begin your form and come back to it later
by following the directions on the confirmation message your receive AFTER you click the Submit button..

Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Age
Child's Date of Birth
MM
/
DD
/
YYYY
Grade Child IS GOING INTO
Name of School Child Attends
Name of School Child Attends IF NOT LISTED
(please do not answer this question if you selected a school in the previous question)
Your answer
Name of Church Child Attends
Your answer
Parent's First Name *
Your answer
Parent's Last Name *
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip code
Your answer
Main or Primary Phone *
Your answer
Secondary Phone #
Your answer
Email address
Your answer
Emergency Contact Person Other Than You
Your answer
Emergency Contact Person's Main Phone
Your answer
Emergency Contact Person's Secondary Phone
Your answer
Child's Allergies or Medical Conditions
Please type "none" if none
Your answer
Emergency Medical Consent *
In the event of an emergency, I hereby give permission to the medical personnel selected by First Methodist Lockhart, Texas staff or VBS chairpersons to order x-rays, routine tests, treatment, to release any records necessary for insurance purposes, and to provide or arrange necessary related transportation for me and/or my child. I understand that no accident/medical insurance is provided with this activity.
Required
Emergency Medical Consent Confirmation
Please type YOUR FIRST AND LAST NAME in the box below to serve as your digital signature to cofirm your answer in the previous question about giving consent to First Methodist Lockhart, Texas in the event of a medical emergency.
Your answer
Emergency Medical Consent Confirmation Date
Please type today's date in the box as part of your digital signature for Emergency Medical Consent.
Your answer
Liability Release
I understand that First Methodist Lockhart, Texas assumes no responsibility for injuries or illnesses which my child may sustain as a result of participation in Vacation Bible School 2014. I acknowledge that I assume the risk for any and all injury and illness which may result from participation in VBS. In consideration of the privilege of participating in Vacation Bible School at First Methodist Lockhart, Texas, I hereby voluntarily release and discharge First Methodist Lockhart, Texas and its agents, servants, volunteers, and employees from any and all claims for injury, illness, death, loss, or damage which may be suffered as a result of participation in VBS. A parent/responsible party must discuss with one of the VBS chairpersons any special conditions or circumstances involving their child prior to participation.
Liability Release Confirmation
Please type YOUR FIRST AND LAST NAME in the box below to serve as your digital signature to cofirm your answer in the previous question about releasing First Methodist Lockhart, Texas from liability.
Your answer
Liability Release Confirmation Date
Please type today's date in the box as part of your digital signature for Liability Release.
Your answer
Child's Picture on Church Webpage
Please check YES or NO below regarding your permission to use your child's picture on the First Methodist Lockhart, Texas church webpage for promotional purposes. YOUR CHILD'S *NAME* WILL NEVER BE USED ON OUR WEBPAGE.
Picture on Webpage Confirmation
Please type YOUR FIRST AND LAST NAME in the box below to serve as your digital signature to confirm your answer in the previous question about using your child's picture on the church webpage.
Your answer
Picture on Webpage Confirmation Date
Please type today's date in the box as part of your digital signature regarding your child's picture on the church webpage..
Your answer
Adult Bible Study
We will have an Adult Bible Study during VBS from 6:30-8pm. Nursery Care will be available during this time. For planning purposes, please check one box.
Nursery care for Bible study
If you plan to attend the adult Bible Study, please check below whether or not you will need nursery care for children 4 and under.
Multiple children
Please check this box if you are registering more than one child
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