Vacation Bible School 2022:  Great Big Beautiful World
Sunday, July 17 through Wed, July 20 - 5:30pm - 8pm
Mount Pleasant United Methodist Church - 5120 Burlington Rd, Greensboro, NC 27405 - (336) 697-0444

We have fun activities prepared and look forward to seeing you as we serve God and our community!
For kids age 3 through grade 5.

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Child's name: *
Child's Birthdate (mm/dd/yyyy): *
Last Grade Completed: *
First and Last Name of Parent(s)/Guardian(s): *
Mailing Address, with Zipcode *
Phone Number *
E-mail *
Allergies or Medical Conditions?: *
Emergency Contact (Name and Phone): *
Emergency Contact (Relationship to child) *
Person(s) who will pick child up each day: *
Home Church: *
Child's School: *
PERMISSION FOR EMERGENCY PROCEDURES - e-SIGNATURE AND DATE: *
I have filled out all information on the top of this form concerning my child and hereby give my permission for my child to go to the activities listed on the top of this form. I understand that the church staff members and volunteers at these events will use their best efforts to supervise my child. However, I also understand that church staff and volunteers are not responsible for loss of personal property or bodily injury. If I or my other contacts cannot be reached at the time of an emergency or if treatment is urgent in the judgment of the church staff and medical authorities, I authorize and direct the attending church staff members to send my child (properly accompanied) to the hospital or to the most easily accessible medical facility. I understand that I will assume full responsibility for the payment of any services rendered. In the event that my child suffers any illness or accident requiring emergency hospitalization while at this event, I hereby give permission for such treatment. I also give permission to a physician to secure proper treatment for my child and to order x-rays, routine tests, and anesthesia if needed. I will not hold Mount Pleasant United Methodist Church nor its staff nor its volunteers responsible in the event of accident or loss
PERMISSION TO PARTICIPATE - e-SIGNATURE AND DATE: *
I understand the emergency procedures listed above and hereby give permission for my child, to attend the activities sponsored by Mount Pleasant UMC and to participate fully in such activities.
PHOTO RELEASE - e-SIGNATURE IF YES:
From time to time, photos of events and activities are taken and shared with our church family through bulletin boards and church media. At no time will names or personal information be shared concerning who is in a group or individual photograph. I give the church permission to use photos of these events for this purpose.
Additional notes or helpful information:
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This form was created inside of Mount Pleasant United Methodist Church.