2019 Multiple Students VBS Registration Form ~ River of Living Water UMC
Vacation Bible School Theme: "To Mars and Beyond" ~ Explore Where God's Power Can Take You!
Date: June 17–21, 2017;  Time: 5:30 pm – 7:30 pm
Location: 1401 Jones Dairy Road, Jasper, Alabama

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Email *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Address   *
Primary contact number *
Cell number
Home number
Work
I would like to receive
Emergency Contact: Name & phone number *
Names & phone numbers of persons who may pick up child/children from VBS *
PLEASE COMPLETE
Information on each child you are registering; Up to 6 on this form covered by information given above.
Student's First and Last Name *
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's Age *
School grade in fall of 2019 *
Allergies/Medical Information/Other
Student's First & Last Name
Student's Date of Birth
MM
/
DD
/
YYYY
Student's Age
School grade in fall of 2019
Allergies/Medical Information/Other
Student's First & Last Name
Student's Date of Birth
MM
/
DD
/
YYYY
Student's Age
 School grade in fall of 2019 (Required)
Allergies/Medical Information/Other
Student's First & Last Name
Student's Date of Birth
MM
/
DD
/
YYYY
Student's Age
School grade in fall of 2019
Allergies/Medical Information/Other
Student's First & Last Name
Student's Date of Birth
MM
/
DD
/
YYYY
Student's Age
School grade in fall of 2019 (Required)
Allergies/Medical Information/Other
Student's First & Last Name
Student's Date of Birth
MM
/
DD
/
YYYY
Student's Age
School grade in fall of 2019 (Required)
Allergies/Medical Information/Other
River of Living Water UM Church/VBS has my permission to use my child’s photograph publicly in VBS materials such as print publications, presentations and online publications. *
PLEASE BE SURE TO SUBMIT FORM
Need more information? Please call church office at 205-387-7603  or email contact@riveroflivingwaterumc.org
A copy of your responses will be emailed to the address you provided.
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