Child's Name
Parent/Guardian Name
Street Address
City, State ZIP Code
E-Mail address
Home Phone (Include Area Code)
Cell Phone
Work Phone
Date of birth Age Last school grade completed
Home Church
Returning Attendee to PHUMC Vacation Bible School?
Allergies/Medical Information/Other Notes
Emergency Contacts Name Phone Name Phone
Dismissal Information Name(s) of persons who may pick up this child from VBS Name
Name
