2019 Vacation Bible School Registration
Mifflin Avenue United Methodist Church will be hosting Vacation Bible School July 15-19, between the hours of 9 AM and 12 PM for children ages 3 years through finishing 6th grade. The address of the church is:
905 Mifflin Avenue
Pittsburgh, PA 15221

You or the person responsible for your child must be present with your child on the first day in order to provide a signature and pay the $5 registration fee.

To confirm the receipt of your registration, you will receive an email with a copy of your registration information.

Email address *
Parent's Name *
Your answer
Child's Name *
Your answer
Address *
Your answer
Phone Number *
Your answer
Child's Birth Date *
MM
/
DD
/
YYYY
Grade in Fall 2019 *
Emergency Contact Name *
Your answer
Emergency Contact Relationship to Child *
Your answer
Emergency Contact Phone *
Your answer
Medical Concerns
Your answer
Food Allergies
Your answer
I acknowledge that I or the person responsible for my child must be present on the first day of Vacation Bible School in order to provide a signature and pay the $5 registration fee. *
Required
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Mifflin Avenue United Methodist Church.