VBS Registration United Methodist Church Los Banos (Campers should be Entering K-6th grade)
Event Dates and Times : July 1-5, 9 am-12 noon
Event Address: 1031 Iowa Ave. Los Banos, CA
Contact: 209-826-4181 or losbanosunitedmethodist@gmail.com
Camper Name: *
Your answer
Email: *
Your answer
Address: *
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Phone: *
Your answer
Age July 1st: *
Required
Grade in the Fall: *
Required
Gender: *
Primary Emergency Contact. Include Name, Phone and Relationship to child: *
Your answer
Secondary Emergency Contact Include Name, Phone and Relationship to child: *
Your answer
*****In case of emergency, I understand that the VBS leaders will make every effort to contact the parents, guardians or emergency contact persons named above, prior to any treatment. I also giver permission for the leaders of VBS to take necessary action for the health of my child in the event that the parents, guardians or emergency contact persons cannot be reached. VBS assumes no financial responsibility. ****** *
Required
Insurance Company and Policy Number: *
Your answer
Please list any health concerns or allergies of the child attending: *
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Are there any custody issues that we should be aware of? Please explain if yes. *
Your answer
How did you hear about VBS? *
Your answer
What church do you regularly attend? *
Your answer
We will be taking group and individual photos. We plan to distribute them to the children involved in VBS and will use some to promote our program on our website and Facebook. Mark: "Yes" if you allow this action. "No" if you do not. *
T-SHIRT INFORMATION for Camper: *
*******PARENTS************** *
Required
I understand there is no cost to me for VBS but I am willing to donate (_) toward this VBS program so it can continue to service the youth of our community.: *
Required
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