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VBS Registration
Chester United Methodist Church * June 19-23, 2023, from 9:00 AM - 12:10 PM
For ages Pre-K through 5th Grade (grade completed)
Please complete a separate form for each child.
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* Indicates required question
Student's Name
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Your answer
Student's Gender
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Female
Male
Parent/Family/Guardian Name
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Your answer
Mailing Address
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Your answer
E-mail Address
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Your answer
Phone Numbers (Any/All) Include name next to each number.
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Current Age
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Your answer
Last School Grade Completed (as of June 2023)
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Your answer
Allergies
Your answer
Special Needs/Medical Info/Other
Your answer
Emergency Contacts (Include name and phone number for each)
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Your answer
Name of person(s) who may pick up from VBS
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Your answer
Do you give CUMC permission to include your child's picture in CUMC social media and publications?
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Yes
No
Type your name and today's date below. This will serve as a digital parent/guardian signature.
*
Your answer
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