VBS REGISTATION FORM

July 14 – 18, 2019

5:00 – 8:00 pm (meal at 5:00)

Pre-K through 4th grade

(One form per family)

Child's Name *

Age *

Child's Name

Age

Child's Name

Age

Child's Name

Age

Crewmates (Please list any crewmate (friend) requests here and we will try our best to accommodate.)

Name of Parent(s) *

Street Address *

City *

State *

Zip *

Home Telephone

Cell Phone

Home E-mail Address *

Home Church

Name(s) of others, beside parents, permitted to sign child(ren) out:

Photo Release: Murphysboro UMC/VBS has my permission to use my child’s photograph in VBS. I understand the images may be used in slide shows during VBS and the Sunday service performance following the end of VBS.

Parent/Guardian’s electronic signature: Date

Allergies or other medical conditions

In case of emergency, contact: *

Contact Phone Number(s) *

Relationship to child *

Would you like the VBS music CD ($7) ordered for your family?
YesNo

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