VBS Registration Form

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Registration form for VBS at Bethel United Methodist Church (481 Delsea Drive, Sewell, NJ 08080)

DATES: Monday 6/20 through Friday 6/24
TIME: 6:00 PM - 8:30 PM
AGES: 4 through 11 years old

PLEASE SUBMIT ONE FORM PER CHILD.

For more information call: 856-589-1745

Email *

Child's Name: *

Child's Age (4 through 11 yrs old): *

Last School Grade Completed: *

Name of Parent(s) or Guardian: *

Parent/Guardian email address: *

Home Street Address: *

City: *

State: *

Zip code: *

Home Phone #: *

Cell Phone #:

Child's Allergies (specify "None" if child does not have any allergies): *

Child's Medications (specify "None" if child does not take any medications): *

In case of emergency, contact (name): *

Emergency contact phone number: *

Insurance Company: *

Insurance ID # *

Insurance Group # *

List any medical conditions that would prevent your child from participating in active sports, climbing stair, etc.:

Send me a copy of my responses.

Submit

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