VBS Registration Form  (potty trained 3 years thru 5th grade)                                          
Families please complete one form per child. VBS will be held June 20-24, 2022 from 9am-noon
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Email *
Child's Name: *
Date of birth of your child: *
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Completed school grade: *
Sex: *
Child's Address: *
Church Affiliation:
Parent/Guardian's Name: *
Parent/Guardian's Email Address: *
Parent/Guardian's Cell Phone number: *
Person to be contacted in case of emergency (please include name/phone number/relationship to child): *
Does your child have any medical conditions that we should be aware of? (allergies, medications, etc.)  If so, please explain: *
IF YOUR CHILD HAS A FOOD ALLERGY PLEASE BRING AN ALTERNATIVE SNACK!
Siblings who will also be attending:
My child would like to be in class with the following friend:
In the event that a parent/guardian and emergency contact cannot be reached in an EMERGENCY, I hereby give permission to the physician selected by the Director of Children's Ministry to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for my child as named above. I also agree that any photographs taken of my child at or during this event are the property of Covenant United Methodist Church and may be used in future publications as deemed appropriate. *
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Insurance Company Name and Phone:
Child's Tee shirt size ($15 for each tee shirt with a family cap of $30) *
A copy of your responses will be emailed to the address you provided.
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