VBS Registration

Child's Name:

Gender:

Male
Female

Age:

Birthdate:

-- mm/dd/yy

Grade entering Fall 2009:

PARENT/CUSTODIAN NAME(S):

Address:

City/State/zip:

Email Address:

Home Phone:

Work Phone:

Cell Phone:

Home Church:

Allergies/Medical Information/Other

Emergency Contact Name:

Relationship:

Home Phone Emergency Contact:

Work Phone Emergency Contact:

Cell Phone Emergency Contact:

How did you hear about our VBS program?

East Cross Website           Early Childhood Center       
Church Marquee               East Cross Community Picnic
Friend                       Relative                     
Radio                        Newspaper                  
TV                           

By Submitting this form I acknowledge that I have been informed and understand that East Cross United Methodist Church will be taking photographs of children attending VBS and that these pictures may be viewed inside the church building and/or on their website.  Submitting this form grants East Cross United Methodist Church the right to use pictures of my child for the reasons stated above.

ONLINE REGISTRATION WILL REQUIRE PARENT/CUSTODIAN SIGNATURE ON FIRST DAY OF ATTENDANCE