Vacation Bible School Student Registration

Vacation Bible School will be held from July 23-27, 9:00a-12:00n, Friday will be extended to 12:30 for the closing program.

Please register no later than June 29, 2012. Supplies are ordered based on the number of registrations received by that date.

VBS is offered to children age 4 (by June 1st) through children who have graduated from 6th grade.
Students will be placed in the VBS classroom of the grade that they have just completed.

Please complete one form per student.


STUDENT INFORMATION:

Child's Name:  
Date of Birth:  
Grade Completed in June 2012:
Preschool3:       Pre-K4:       K:       1st:       2nd:       3rd:       4th:       5th:       6th:      

Parent/Guardian Name:  
Address:  
Home Phone:  
Other Phone:  
Home Church:  
Email:  
(confirmation and reminders will be sent via email)

EMERGENCY INFORMATION

Please provide two emergency contacts and two phone numbers for each contact.

Emergency Contact #1 Name:   Phone:   Alt. Phone:  
Emergency Contact #2 Name:   Phone:   Alt. Phone:  

AUTHORIZED PICK UP

Please list any people authorized to pick your child up from VBS along with their phone number.

Name:   Phone:  
Name:   Phone:  
Name:   Phone:  
Additional
if needed:  


Please list any allergies or medical conditions:  
Instructions for treatment:  
(Food Allergies: Please include specific information. You will be contacted by the director prior to VBS week.)

PHOTO PERMISSION

I DO                 I DO NOT
give permission for my child’s photograph to be taken and used for VBS purposes.

If you have any questions please contact: Stacey Chandler, Director of Vacation Bible School at 610-459-2911 or vbs@elamumc.org.