Nelson United Methodist Church Vacation Bible School Registration (One per Child)
Date: July 22nd - 25th, 2018
Potluck Dinner: July 22, 5:00 p.m.
Time: 5:30 p.m. - 8:30 p.m. (Dinner begins at 5:30 p.m.)
Address: 5239 Thomas Nelson Highway, Arrington, VA 22922
Contact us at (434) 263-5652 or nelsonumc@gmail.com
Vacation Bible School: Shipwrecked
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Gender *
Child's Age *
Your answer
Date of Birth *
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DD
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YYYY
Last school grade completed *
Your answer
Name of parent(s) *
Your answer
Street address *
Your answer
City *
Your answer
State *
Your answer
ZIP *
Your answer
Home telephone *
Your answer
Parent/caregiver's cellphone *
Your answer
Home email *
Your answer
Home church
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Allergies or other medical conditions
Your answer
In case of emergency, contact person: *
Your answer
In case of emergency, contact phone: *
Your answer
Relationship to child *
Your answer
I give my consent for the use of any photography and/or video of my child in future displays or publications of Nelson UMC *
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