AMPED VBS - Participant
Registration / Vacation Bible School / Chapel Hill United Methodist Church / 2601 Hwy 60 East, Henderson, KY
Participant First Name *
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Participant Last Name *
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Date of Birth *
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Gender *
Grade Entering as of Fall 2018 *
Street Address *
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Street Address Line 2
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City *
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State *
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Zip Code *
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Allergies / Special Needs
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Will your child be eating the FREE meal at 5:30 p.m. each night? *
1st Emergency / Parent / Guardian Contact *
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1st Emergency Contact Phone Number *
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2nd Emergency / Parent / Guardian Contact *
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2nd Emergency Contact Phone Number *
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Would you like to be contacted regarding our children's programming? *
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