Polk Street United Methodist Church - VBS Kids Registration

June 19 - 22

9 AM - 12 PM

Open for kids entering Kindergarten through 5th grade

Child 1 (Required)

First Name

Last Name

Grade Completed

Birthday

Age

Shirt Size

Parent Name(s)

Home Address

Phone Number

Emergency Contact Name

Emergency Contact Phone Number

Food allergies?
Yes
No

If yes, please list:

Medical concerns?
Yes
No

If yes, please list:

Family Doctor Name

Family Doctor Phone Number

Do you have a home church?
Yes
No

If so, where?

Name of person(s) who has permission to pick up

Permission to take pictures and post on media?
Yes
No

Any other comments

Child 2 (if applicable)

First Name

Last Name

Grade Completed

Birthday

Age

Shirt Size

Food allergies
Yes
No

If yes, please list:

Medical concerns?
Yes
No

If yes, please list:

Permission to take pictures and post on media?
Yes
No

Any other comments?

Child 3 (if applicable)

First Name

Last Name

Grade Completed

Birthday

Age

Shirt Size

Food allergies?
Yes
No

If yes, please list:

Medical concerns?
Yes
No

If yes, please list:

Permission to take pictures and post on media?
Yes
No

Any other comments?

Submit

VBS Kids Registration

June 19 - 22

Child 1 (Required)

Child 2 (if applicable)

Child 3 (if applicable)

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