United Methodist Church of Mount Pleasant
Wednesday, May 22, 2019
The Town Clock Church

 

VBS Registration - One Form Per Child

 
Child's Name:
Child's Age:   Date of Birth:
Last Grade Completed:
Name of Parent(s):
Street Address:City:
State:Zip Code:
Home Telephone:                                                                Parents/caregiver's cell phone:
Email:
Home Church Name (if applicable):
Allergies or Medical Conditions:
If Parent cannot be reached, please contact:
  Relationship:      Phone:   
 
CREW MEMBER OR NAME (FOR CHURCH USE ONLY):
I hereby give my permission for use of my child's photograph by the church to be used during worship or for advertising purposes by inserting my name below as my signature: