VBS 2008
 
     
 

Registration Form

 
 
Child's Name:

Parent/Guardian's Name:

Address:

E-mail Address:

Phone Numbers:
 
Home:
 
Cell:
 
Work:
Age Information:
 
Date of Birth:
 
Age:
 
Last school grade completed :

Home Church:
Allergies/Medical Information/Other:


Emergency Contacts:
 
Name:
Phone:
 
Name:
Phone:

Dismissal Information:
Name(s) of person(s) who may pick up this child from VBS:


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Emmanuel United Methodist Church
16000 Cumberland Road, Noblesville, Indiana 46060
Phone: (317) 773-4406  Fax: (317) 773-9165