Vacation Bible School at University Presbyterian Church

July 30-August 3 | 9 a.m. to Noon
Please complete the following form to enroll your child in Vacation Bible School at University Presbyterian Church.
Child's Name:
Parent/Guardian Name:
Child's Nickname/Preferred Name:
Zip Code:
Home Phone:
Cell/Alternative Phone:
E-mail Address:
Child's Date of Birth:
Child's Sex:
Last School Grade Completed:
Sibling/s Name/s:
In case of an emergency (if parent/guardian cannot be reached), please contact:
Emergency Contact Name:
Emergency Contact Phone:
Emergency Contact's Relationship to Child:
Please list any allergies/medication/medical needs that VBS staff should be aware of:
Person/s allowed to pick up this child at the end of each VBS day (if this is left blank, the only person that will be allowed to pick up your child will be the Parent/Guardian listed at the top of this form):
Phone Number/s of Person/s allowed to pick up your child:
Other information that you would like us to know about your child:
This will be my childs first VBS experience.
Any special needs or circumstances we should be made aware of about your child?
Would you like to help volunteer for VBS?
What position would you like to volunteer for?
What days are you available to volunteer?
I understand that my child may be photographed as a part of documenting for future VBS events and these photographs may be used for future advertisement use. We will do our best to not photograph close-up faces. *
Verification Code:
Insert above code:
 * Required

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