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Child's Name *

Please enter the first and last name of the child you are registering.

Parent|Guardian Name *

Please enter the first and last name of the parent or guardian responsible for the child being registered.

Phone Number *

Please enter a phone number (preferably cell) where the parent-guardian can be reached.

Email Address *

Please provide an email where you can be reached

Address *

Address

City

State/Province

Zip/Postal

Country

Please provide the address where the child is currently living.

Birthday of the Child *

Please enter birthday - MM/DD/YYYY

Age of the Child *

Please provide the current age of the child.

Grade Child is Entering *

What grade will the child be attending when they enter school this fall?

Mother's Name *

Please provide the name of the child's mother.

Father's Name *

Please provide the name of the child's father.

Emergency Contact Name *

Please provide a name of a person to call in case of an emergency.

Emergency Contact Phone Number *

Please provide a phone number to reach the emergency contact.

Does the child have allergies? *

Yes

No

Please let us know if the child has allergies - food, pollen, trees, etc.

If you answered "yes" to allergies, please list all allergies below: *

Please list all known allergies of the child attending VBS.

Preferred Hospital *

In case of emergency, what hospital would you prefer you child be taken to?

Are you a member of Wesley United Methodist Church?

Yes

No

Where will the responsible party be while VBS is in session?

Please provide where the parent-guardian might be during VBS sessions. Parent-guardians should be present during Friday's dinner.

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