Shipwrecked VBS Registration Form
July 30 - August 3
6:30-8:30 PM
(Monday-Thursday: Station Rotations, Friday: Performance and Ice Cream Social)
Aldersgate United Methodist Church 460 W. Aldersgate Drive, Nixa, MO 65714

For children age 3 through entering 6th grade.

Please complete a separate form for each child!
Child's Name *
Your answer
Child's Gender *
Child's Age *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Grade Entering in the Fall *
Your answer
Does your child have any allergies/medical conditions that we should know about? *
Your answer
Home address *
Your answer
Home Phone Number
Your answer
Father's Name *
Your answer
Father's Cell Phone Number *
Your answer
Mother's Name *
Your answer
Mother's Cell Phone Number *
Your answer
Alternate Emergency Contact Name and Phone Number (if parents cannot be reached) *
Your answer
Family Email Address
Your answer
Home Church *
Your answer
Photo/Video Release *
Does your child need transportation?
Name of a friend your child might want to be with?
Your answer
Is there any other information that we should know?
Your answer
Name of Person Completing This Form: *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms