West Newton UMC

Events

2018 VBS Registration form

Student's Name *

First

Last

Parent/Family/Guardian Name *

First

Last

Address *

Home Phone

Home phone, including area code

Work Phone

Work phone, including area code

Cell Phone

Cell phone, including area code

Email *

Dismissal Info *

Name(s) of person(s) who may pick up this child from VBS

Student's Date of Birth *

Last School Grade Completed *

Home Church

Friends of your child at WNUMC (if any)

Special Needs/Allergies/Medical Information/Other: *

Required; if none, please enter "none"

Emergency Contact *

Name and phone number of emergency contact

Permission to take child's photo? *

Name

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