Vacation Bible School Registration – Lexington United Methodist Church

VBS is just around the corner! July 15th – 17th! 6:00 – 8:30pm.

There will be a preschool group for 3 and 4 year olds.

(One form per child please)

Parent/Guardian Names

First Name	Last Name

Email
Home Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Work Phone
Emergency Contact Person
First Last
Additional Emergency Contact Person
First Last
Relationship to Student
Food Allergies
- Yes
- No
Please List Allergies or other Medical Information
Family Doctor
Doctor's Phone
Siblings Attending

(Names and Ages)
Church Affiliation
Church Membership at
Friends of Your Child at this Church
Person(s) Who May Pick Up Child
Name Phone
Transportation Needed?
- Yes
- No
Vacation Bible School (VBS) leaders have permission to photograph/film the minor(s) designated above for any lawful purpose associated with this VBS program.
Signature