VBS Registration Form 2021
June 28 - July 2nd from 6-8:30pm

Westside Community UMC looks forward to seeing your child at VBS this year! Please complete a separate registration form for each child who will be attending. Children who register by June 10th will have a prize mailed to them. Thank you!
First and Last Name of Child *
Child's Birthdate *
Last School Grade Completed: *
Address *
Medical Concerns/Allergies *
Name of Parent/Caregiver *
Primary Phone Number *
Secondary Phone Number
Emergency Contact *
Emergency Phone Number *
Church Affiliation (optional)
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