2019 VBS Signup – FUMC Bryant

Child's Name *

First

Last

Sex

Address

Street, City, State

Zip Code

Age on June 1, 2019

Grade Completed as of June 1, 2019

Email *

Confirm Email

Phone Number

Parent or Guardian Name

Parent/Guardian Address (If Different From Child)

Emergency Contact *

First

Last

Emergency Contact Phone Number

Allergies or conditions which may limit activity

Medical Concerns

EPI Pen

Social Behavior/Concerns

Pediatrician Name

Pediatrician Phone Number

Church Child Attends

Member?

Does your child have permission to be picked up by someone other than yourself/guardian?

Media & Safety Release

In registering my child for VBS, I give permission to Bryant First United Methodist Church to use my child's voice, video and/or photo in future promotional pieces. I also allow the staff to administer basic first aid if needed. BY PUTTING MY NAME IN THE BOX ABOVE I AGREE TO THIS POLICY

Name