Vacation Bible School Registration 2019

Child #1 Name

Gender

Male Female

Date of Birth

Grade just completed

Allergies or other important information

For multiple chidren, please fill out continued form below.

parent name

Phone

This address will receive a confirmation email

Child's Doctor name and phone number

Child # 2 name

gender male female

child's date of birth

Grade just completed preschool kinder 1st grade 2nd grade 3rd grade 4th grade 5th grade 6th grade

allergies and other important information

Child # 3 Name

Gender Male Female

Child's date of birth

allergies and other important information

Child # 4 Name

Gender Male Female

Child's Date of Birth

allergies and other important information

I _____ give my permission for my child(ren)'s photo/video clips to be used for WPUMC promotion, celebration, advertising, etc.

DO DO NOT

I hereby give permission for WPUMC to call 911 for medical care for above named child(ren) should an emergency occur. I understand that a conscientious effort will be made to locate the parent named above before any action is taken as circumstances of the emergency allow. It is further understood that all expenses associated with emergency action taken are the responsibility of the child(ren)'s parents with or without parental communication at the time of the emergency. I will not hold WPUMC responsible for any injury incurred while participating in activities or performing volunteer work for either above named child(ren) or parents.

I understand

Payment

Unnamed Label

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Vacation Bible School Registration 2019

Description

Please Fix the Following