Central Highlands Community United Methodist Church
2009 Vacation Bible School Registration

June 15th - June 19th

9:00 a.m. to 12:00 p.m.

* = Fields are required

Families are invited to VBS on Friday at 11:00 for a celebration that includes:

Special Music program by VBS Kids!

Appearance by the Puppets for the King!

Picnic celebration for all VBS kids and their families at noon!

NOTE: On-Line registrations will be accepted through Thursday, June 11th.

The registration fee must be dropped off at the church office by noon on Friday, June 12th.

*Child First Name:

*Child's Last Name:

*Child's Sex:      *Child's Birth Date:  (mm/dd/yyyy)     

*Child's Age:       *Grade Completed (2009): (K through 5th)

*Child's Address:

*City:          *State:          *Zip:

*Home Telephone:

Cell Phone:

E-Mail Address:

*Parent or Legal Guardian First Name:

*Parent or Legal Guardian Last Name:

*Relationship to Child:

*Parent or Legal Guardian Address:

*City:         *State:          *Zip:

*Home Phone: 

Cell Phone:

Parent or Legal Guardian First Name:

Parent or Legal Guardian Last Name:

Relationship to Child:

Parent or Legal Guardian Address:

City:         State:          Zip:

Home Phone: 

Cell Phone:

Are there any health conditions we should be aware of:

Are there any food allergies?

ALLERGY ALERTS:

In case of emergency, contact:

Name:

Relation to Child:

Home Telephone:

Cell Phone:

Who will be picking up your child daily:

Name:

Relation to Child

Phone:

Are there any siblings or friends attending this function:

Church Affliliation: Member?

Would you like mailings for other events at our church?

Plase list any information or special needs you would like us to know about your child.

*Enter the following code into the box EXACTLY as it appears: 0615