VBS Registration Form 2021

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June 28 - July 2nd from 6-8:30pm

Westside Community UMC looks forward to seeing your child at VBS this year! Please complete a separate registration form for each child (Kindergarten-5th grades) who will be attending. Thank you!

First and Last Name of Child *

Child's Birthdate *

YYYY

Last School Grade Completed: *

Preschool

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

Other:

Address *

Medical Concerns/Allergies *

None

Other:

Name of Parent/Caregiver *

Primary Phone Number *

Secondary Phone Number

Emergency Contact *

Emergency Phone Number *

Church Affiliation (optional)

Submit

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