2018 Vacation Bible School Registration Form
All kids 4 years old through new 6th graders are invited to Rolling River Rampage Vacation Bible School!
June 18th-22nd 9am-12:15pm


Lenexa United Methodist Church
9138 Caenen Lake Road Lenexa, KS 66215
913-888-5600
Mary.Clow@lenexaumc.org


Early Bird Registration through May 27th
$10 per child, $25 cap per family

Regular Registration May 28th – June 7th
$15 per child, $40 cap per family

NO REGISTRATIONS WILL BE ACCEPTED AFTER JUNE 7

*Registration fees are waived for children of a parent/guardian who can work ALL 5 days of VBS!
Nursery care is available for teachers’ children under 4.

There are scholarships for families in need. Contact Mary Clow, Director of Children’s Ministries,
for information 913-888-5600 or mary.clow@lenexaumc.org.

Child's Name *
Your answer
Gender
Your answer
Parent(s)/Guardian(s)'s Name(s) *
Your answer
School Grade Fall 2018 *
Birth Date *
MM
/
DD
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YYYY
Age (Children must be 4 by June 18, 2018 and potty trained) *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Contact Numbers During VBS *
Your answer
Email
Your answer
Special Needs, Health Alerts, and/or Allergies
Your answer
Emergency Contacts (names and phone numbers if a parent/guardian is unreachable) *
Your answer
My Child May Be Picked Up By (Name and Relationship to Child)
Your answer
I Wish My Child To Be In Class With (Every effort will be made to honor these wishes)
Your answer
How did you hear about our VBS?
Your answer
Do you currently have a church home, and if so, where?
Your answer
Do you need afternoon care? Afternoon childcare is available from 12:15–5pm the week of VBS for working parents/guardians. Lunch is provided. A love offering donation is accepted to help cover the costs of aftercare. If you need afternoon care, what days/times?
Your answer
How can you help?
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