Family Last Name:  * Email:  * Address:  * Zip code:  *

Moms Cell Phone  * Dads Cell Phone  * Emergency Contact Name  * Emergency Contact Phone  *

Children's Information

1st Child Name  * 1st Child Friend Request  * 1st Child age on 7/16 or grade going into Make Selection for child 1under two years2yr3yr4yr5yrGoing into Kindergarten 1st Grade 2nd Grade3rd Grade4th Grade 5th Gradegoing into 6th grade

2nd Child Name 2nd Child Friend Request 2nd Child Age 7/16 or grade going into Make Selection for Child 2under 2 years2yr3yr4yr5yrGoing into Kindergarten 1st Grade2nd Grade3rd Grade4th Grade5th Gradegoing into 6th grade

3rd Childs First Name 3rd Child Friend Request 3rd Child Age 7/16 or grade going into Make Selection for Child 3under 2 years2yr3yr4yr5yrGoing into Kindergarten 1st Grade2nd Grade3rd Grade4th Grade 5th GradeGoing into 6th grade

Other Information   I would like to volunteer to help During VBS YES NO I give permission for my child(ren) to attend VBS at MDUMC. I understand that pictures will be taken throughout this event for use on our website and other promotional materials. I understand that in the event my child becomes sick or injured and I cannot be reached the church has my permission to call my emergency contact and release my child to said contact. I understand that it is my responsibility to alert the VBS leaders if my child has any special needs allergies etc. Initial here to give permission. Permission Make SelectionPermission Granted If any of your children have special needs or health concerns. Please list the child's name and special concerns. Name and Concerns Do not enter anything in this field: