To Mars and Beyond-2019 VBS
Event Timing: June 24th-27th; 5:30 pm to 8:00 pm
Event Location: First United Methodist Church of Lake Jackson
Contact us at (979) 297-3046 / children@ljfumc.org

PLEASE COMPLETE ONE FORM PER CAMPER

Email address *
Camper's Name *
Your answer
Age of Camper as of Sept. 1, 2018 *
Camper's Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian Name *
Your answer
Telephone *
Your answer
Primary Language Spoken in the home *
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Last school grade completed by camper *
Do you have a home church? If so, where?
Your answer
Allergies/ Medications/ other info *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Dismissal info: Name(s) of person(s) allowed to pick up this child *
Your answer
Are you bringing a friend that you'd like to be grouped with? Please list their name.
Your answer
Does your child have special needs? *
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