Middlebrook Pike United Methodist Church Vacation Bible School Registration. Jump on the Rolling River Rampage. June 4 - 8, 2018
Please complete one form per family
Parent/Guardian Name (S) *
Your answer
Home Address: *
Your answer
City *
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State *
Zip Code *
Your answer
Phone Number *
Your answer
Additional Phone Number
Your answer
Additional Phone Number
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Email (for VBS communication) *
Your answer
Please base your answers on child's grade in school next year.
Your answer
Child one name *
Your answer
Child one age *
List Allergies or state none *
Your answer
List Medical Issues or state none *
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Child two name
Your answer
Child two age
List Allergies or state none
Your answer
List Medical Issues or state none
Your answer
Child three name
Your answer
Child three age
List Medical Issues or state none
Your answer
List Allergies or state none
Your answer
Child four name
Your answer
Child four age
List Allergies or state none
Your answer
List Medical Issues or state none
Your answer
Carpooling? All parents will pick up their children at the end of each night via a car line (you will be notified of your pick-up location via email). If you will be carpooling AT ANY TIME during the week of VBS, please indicate on the lines below, the names (first & last) of others who will be picking up your child from VBS.
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