Down On The Farm Registration
Event Timing: June 17-20, 2019, 9am - 11:30am
Event Address: Durand United Methodist Church, 102 East Main Street, Durand, IL 61024
Contact us at: (815) 248-2461 or churchoffice@durandumc.org
Cost per child: Early Bird (before May 31) is $5; After May 31 is $8.
Child's Name Attending (first and last) *
Your answer
Child's Age *
Your answer
2nd Child's Name (first and last)
Your answer
2nd Child's Age
Your answer
3rd Child's Name (first and last)
Your answer
3rd Child's Age
Your answer
Dietary restrictions *
Parent or Guardian's Name (first and last) *
Your answer
Street Address *
Your answer
City, State, Zip *
Your answer
Phone (home, mobile) *
Your answer
Email Address *
Your answer
Emergency Contact Name and Phone Number *
Your answer
Allergies or Medical Conditions
Your answer
Would you like to help with VBS?
By checking the box below the parent or guardian of the above named youth hereby grants permission for the use of VBS participant's image in Trinity Lutheran Church or the United Methodist Church's and synodical publications or in newspapers as long as the participant's name or address are not published. *
Please check one
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.