Vacation Bible School Registration

Please fill out the form below to register your child for Vacation Bible School

Child Information

Child's Name

Preferred Name

Parent's Name

Parent's E-Mail

Address

City

State

Zip

Phone

Birthdate

Gender

Conditions which my limit activity

If your child has special needs of any kind, would you like an adult shadow?

Does your child have any special needs that we need to be aware of?

Does your child have any allergies (food and other) that we should be aware of?

May we use bug/insect repellent on your child?

Emergency Contact Information

Who can pick up your child?

Contact Name

Phone Number

Alternate Phone

Address

City

State

Zip

Alternate Contact

Contact Name

Phone Number

Address

City

State

Zip

Agreement

I understand that in the event medical intervention is needed, every attempt will be made to contact the persons listed on this form. In the event I cannot be reached in an emergency, I hereby give permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or to order an injection, anesthesia, or surgery for my child as deemed necessary. I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed. Coverage by Huntersville United Methodist Church through its accident policy will be used as a backup for what my family

I agree

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Huntersville United Methodist Church serving the University Area, Huntersville, Highland Creek, Cornelius, Davidson and Lake Norman areas

14005 Stumptown Road, Huntersville, NC 28078 | (704) 875-1156

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