2023 VBS Registration Form

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Please complete the form below for each child participating in Discovery on Adventure Island at Lake Harbor United Methodist Church on June 26-29 from 6:00-7:30 p.m.

Email *

Child's Name: *

Parent or Guardian Name: *

Address (include zip code): *

Phone (Please indicate if number can receive texts): *

Child's Date of Birth (m/d/y): *

Child's Age(s): *

Grade child just completed: *

Special Needs/Allergies/Medical Information/Other: *

EMERGENCY CONTACT (name and phone contact): *

Photo Release: Lake Harbor United Methodist Church has my permission to use this child's photograph publicly. I understand the images may be used in print publications, online publications, presentations, websites and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. My signature below authorizes Photo Release. If photo release is not authorized, please write N/A. *

Other than those listed as parent/guardian/caregiver, the following person(s) are authorized to pick up my child from VBS. (Must be 18 years or older) *

A copy of your responses will be emailed to the address you provided.

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