Child Name:
Child Age:
Last Grade Completed:
* Parent Name:
Address:
City:
State:
Postal Code:
Country:
Home Phone:
Work Phone:
Cell Phone:
* E-mail:
Emergency Contact:
Emergency Phone:
Who will pick up the child?:
Any special needs?:
Home Church:
Name of friend of the child?:
Categories check all that apply	VBS Registration

	If you can't read the image, refresh the page or Listen to the code
For spam and security reasons
Please enter code from image:

In submitting this form, I hereby release RUMC, the leaders, and pastor from responsibility and liability for any injury or illness that my child may sustain during this activity/event. In the event of an emergency, I hereby authorize an adult leader of this group, as agent for me, to consent to examination and treatment as advised by a physician. I expect to be contacted as soon as possible. I give my permission for over the counter medications to be given for minor discomforts.

In submitting this form, I give my permission for my child to be transported by a leader or the pastor during this activity/event if necessary.

Home | Who We Are | Where & When | Worship | Kids & Youth | Adults | Resources | Contact