2019 Pleasant Valley UMC Vacation Bible School
2019 Camp Details:

* Camp Week - July 15-19, 9 a.m. to noon daily

* Camp Location - PVUMC Community Outreach Center, 25350 Poland Rd. Chantilly, VA

* Registration Fee: $35 per child, Maximum Fee $70 per family

Registration Details:

* Fill out one form per child (Age 4 - rising 6th Grade)

* Make Check Payable to PVUMC, Note VBS and number of registrations.
Mail or drop off at PVUMC, 43987 John Mosby Hwy. Chantilly VA 20152. Or pay online (http://tinyurl.com/jz6kvad)

* Register and Pay by July 1, 2019. Payment must be sent at the time of registration
* Need-Based Scholarships Available, contact the church office for information office@pleasantvalleyumc.net

Child's Age as of July 9th 2019 *
Your answer
Child's Name *
Your answer
2019-2020 Current School Grade *
Street Address *
Your answer
City *
Your answer
State *
Email Address
Your answer
Name of Primary Contact (Parent/Guardian/Other) *
Your answer
Preferred Phone Number *
Your answer
Emergency Contact 1 Name *
Your answer
Emergency Contact 1 Phone Number *
Your answer
Emergency Contact 2 Name
Your answer
Emergency Contact 2 Phone Number
Your answer
Permission *
I give my permission for my child to attend Vacation Bible School at Pleasant Valley United Methodist Church from July 17-21, 2017. I also give my permission for PVUMC Vacation Bible School Leaders to secure and authorize emergency medical treatment for my child if necessary.
Registration Fees *
The registration fee is $35 per child, max of $70 per family. I understand that registration fees are non-refundable.
Child's T-Shirt Size *
This is just in-case we do t-shirts. That has not been decided yet.
Photography Permission *
I give permission for my child to be photographed at PVUMC VBS, and these photos may be used in Pleasant Valley UMC communications.
Will you pay by check, or online?
If online, please pay here: http://tinyurl.com/jz6kvad
Does your child have any allergies, asthma or medical conditions we need to be aware of?
Your answer
Are we allowed to administer the following medications if the child needs it?
Benedryl, Tylenol, Ibuprofen, Tums, Neosporin, Saline Eye Drops
Will you be bringing any medications, epi pens, inhalers, etc for your child? If so, please list.
Your answer
Who will be picking up your child? List all applicable names
Your answer
Is there anyone NOT authorized to pick up your child? If so, who?
Your answer
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