Vacation Bible School Registration July 17-21, 2017• 9 a.m. to Noon
St. Matthew's United Methodist Church
435 Central Street, Acton, MA 01720 • 978-263-2822 • office@saint-matthews.org
(please use one form for each child)
Child's Name: *
Your answer
Parent/Guardian Name(s): *
Your answer
Address: *
Your answer
Email Address: *
Your answer
Home Phone:
Your answer
Cell Phone:
Your answer
Work Phone:
Your answer
Child's Date of Birth: *
MM
/
DD
/
YYYY
Last school grade completed (Spring 2017): *
Your answer
Home Church (if any):
Your answer
Allergies/Medical Information/Special Needs: *
Your answer
Emergency Contacts:
Contact #1 Name: *
Your answer
Contact #1 Phone number" *
Your answer
Contact #2 Name" *
Your answer
Contact #2 Phone number: *
Your answer
Dismissal information: Name(s) of person(s) who may pick up this child from VBS *
Your answer
Photography Release: Occasionally we photograph children and use the photo/video without identifying children in church publications. Please indicate below:Yes, you may use or No, you may not use images of my child/children: *
How did you hear about our Vacation Bible School? *
Your answer
Registration Fee: Early-birds - $25 per child/$40 per family through June 15th; $30 per child/$45 per family after June 15th. For parents or grandparents participating in VBS, deduct $10. Please send the registration fee to St. Matthew's UMC at your earliest convenience. Thank you! Questions? Call 978-263-2822 or email info@saint-matthews.org.
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