VBS Registration
Mt. Healthy United Methodist Church Vacation Bible School Registration June 17-21, 2019
Email address *
Child's Name *
Your answer
Child's Age *
Your answer
Child's Birthday
Your answer
Next year's grade
Parents' Names *
Your answer
Family Address *
Your answer
First Phone Number to Call (please list name and phone number) *
Your answer
Second Phone Number to Call (please list name and phone number) *
Your answer
Third Phone Number to Call (please list name and phone number)
Your answer
Siblings or Friends also attending:
Your answer
Who may pick up child? *
Your answer
Who may NOT pick up the child?
Your answer
What food allergies or medical concerns should we know about?
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In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for the administration of any treatment deemed necessary by above-named doctor, or, in the event the designated preferred practitioner is not available, by another licensed physician; and (2) the transfer of the child to any hospital reasonably accessible. (Please type your name below.) *
Your answer
Doctor to be called: (Please include name and number)
Your answer
I hereby grant to Mt. Healthy United Methodist Church permission to use the images and likenesses of myself and my minor children, in the promotion of the Mission and Ministries of the church, including in house display, print publication, on the Mt. Healthy U.M.C. web page and social media outlets. (Please type your name below.)
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