ROAR VBS Registration 2019
Please fill out a separate registration form for every child attending VBS.
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Household Email Address *
Your answer
Mother's Name *
Your answer
Mother's Cell Number *
Your answer
Mother's Work Number
Your answer
Father's Name *
Your answer
Father's Cell Number *
Your answer
Father's Work Number
Your answer
Allergies
Please list any allergies (food, medication, insects, etc.)
Your answer
Medical Condition(s)
Your answer
School Grade Just Completed *
Name of School *
Your answer
Home Church
Your answer
Permission to use child's photo on the CUMC website, Facebook, and Instagram page *
The photos will be used for informational or promotional purposes only.
Parent/Legal Guardian Signature *
Filling in your name below will serve as your electronic signature.
Your answer
Name(s) of other Adult(s) that have permission to pick up your child
**Adults picking children up must be 18 years of age or older. Please be sure to list any and all adults who might be picking your child up during the week of VBS.
Your answer
T-Shirt Size *
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