Vacation Bible School Registration Form

If you prefer, print the form and complete it manually, then bring it to registration.

 

     High Seas Expedition  August 1 - 5, 2010  at St. Luke's UMC

 

          Please note that the child must be potty-trained and at least 3 years of age.

 

          Name:      

 

          Date of Birth (mm/dd/yy):       Last grade completed (K, 1, 2,...):         Age on August 1st:

 

         Name of parent(s):    

 

          Street address:               City:   

           

           Home phone:                             

 

           Parent / caregiver's cell phone:   

 

           Home email address:  

 

In case of emergency              Contact:                   Relationship to child:    Emergency Phone

 

Allergies or other medical conditions (enter "n/a" if none known): 

 

Home church: