Child's First Name:  * Child's Last Name:  * Birthdate:  * Age as of July 19th:  * Grade as of 09-10:  * Home church:  * T-shirt size (specify Child or Adult):  * Allergies or other medical conditions:  * One friend your child would like to be placed with:  * Mom's name:  * Address:  * City:  * Zip Code:  * Home Phone:  * Cell Phone:  * Dad's name:  * Address:  * City:  * Zip Code:  * Home Phone:  * Cell Phone:  * Family E-mail:  * In case of special circumstances such as illness of my child and I cannot be immediately reached I give permission to the following persons to pick up my child: Emergency Contact:  * Emergency contact phone number:  * Emergency contact 2:  * Emergency Contact 2 phone number:  * I will allow MDUMC to use my child's photo video image or voice or art work for publicity purposes. I agree. I do not wish to register my child. VBS is a volunteer ministry or MDUMC. We rely heavily on the volunteer support of parents and other adults. Please prayerfully choose at least one of the bellow volunteer options. Name of volunteer:  * I would like to discuss volunteer opportunities available during the week of VBS. I have a child four years old or younger. I would like to discuss how I can help with Family Fun Night on Wednesday evening. I would like to discuss volunteer opportunities available in preparation for VBS. I am willing to supply snack items for the Teacher/ Teen Aide Appreciation Room. Please call me with an assignemnt or to make a monetary donation towards the snacks. Do not enter anything in this field:

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