Rocky Railway VBS @ St. John's UMC
July 25-29, 2021
5:30-7:30 PM
109 E. 14th Street, Davenport IA
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Child's Name: (One child per registration) *
Parent/Guardian's Name(s): *
Parent/Guardian's Email *
Parent/Guardian's Phone *
Do you have a family you would like your children to be placed with in their Crew? If so, who? (If you are registering multiple children from the same family, include those names here.)
Emergency contact name and phone number:
Other than the parent/guardian listed above, is there anyone else authorized to pick up the child? (Name, phone number, relationship):
In the event of an emergency, or a situation that is reasonably considered to be an emergency, I, the parent/guardian give permission to St. John’s United Methodist Church to seek and authorize emergency medical care to be given to my child named above. (For example; first aid, medication, anesthesia, or surgery.) This care may be given under whatever conditions are necessary to preserve life, limb, or well being of my dependent. St. John’s UMC will make reasonable attempts to notify parents/guardians prior to authorizing any such emergency care. *
I fully understand that my child must abide by all rules governing conduct and safety while attending St. John’s UMC Vacation Bible School Program activities. *
I give permission for my child to be photographed during activities associated with St. John’s UMC Vacation Bible School. I understand that said photos/videos may be used for the St. John’s VBS program, and that my child’s name will not be used with the image. *
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