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VBS REGISTRATION - FOREST PARK UMC

Child's Full Name

Gender

Male

Female

Birthday

Grade

Mother/Guardian

Father/Guardian

Address

I give Forest Park UMC permission to publish images or video of my child in print or electronic form (Including but not limited to church website, Facebook, etc.)

Yes

No

PHONE NUMBERS

Home

Work

Cell (Mom)

(Dad)

Medical or other information we need to know: (allergies etc)

EMERGENCY CONTACT

(1) Name

(1) Phone

(2) Name

(2) Phone

DISMISSAL INFORMATION

Who may pick up your child at the end of each VBS day?

OTHER INFORMATION

Home Church

I give Forest Park UMC permission to publish images or video of my child in print or electronic form (Including but not limited to church website, Facebook, etc.)

Yes

No

Today's Date

Parent/Guardian Digital Signature (required)

Your information will remain confidential.

Your form has been submitted. Thank You!