VBS Registration Form
July 29-Aug 2 from 9 am to 12 pm, $10/child, Ages 4 yrs-rising 5th grade
Email address *
Child's Name *
Your answer
Child's Age *
Your answer
Date of Birth *
Your answer
Last Grade Completed *
Your answer
Child’s T Shirt Size *
Your answer
Parent's Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone Number *
Your answer
Home Church
Your answer
Special Circumstances (special needs, legal issues, ect.)
Your answer
Persons Allowed to Pick Up Child
Your answer
Allergies or other medical conditions
Your answer
Emergency Contact
Your answer
Emergency Contact Phone Number
Your answer
Emergency Contact Relationship to Child
Your answer
Community UMC has my permission to use my or my child's photograph publicly to promote the church. I understand that the images may be used in print publications, online publications, websites, and social media. I also understand that no royalty, fee or other compensations all be payed to me by reason of such use. *
I understand I need to go to https://www.shelbygiving.com/inline/dedicated/?uid=ncs-2092&amt=NaN and pay $10/child (select other in the drop down box) to complete my registration *
Required
Name of person paying registration fee. *
Your answer
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