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Vacation Bible School

Kids Registration

Vacation Bible School Kids Sign-Up Form

Child's First Name

Child's Last Name

Siblings Attending? Please add their name(s)

Child's Age

Child's Birthdate

Grade Completed

T-Shirt Size (Please choose one for each child)
YXS
YS
YM
YL
YXL
S
M
L
XL

**T-Shirts have already been ordered. Sizes are not guaranteed!**

Emergency Contact Name and Number

Special Needs/Allergies/Other Concerns

Do you give permission for your child to be photographed?
Yes
No

Do you give permission to use any photos of your child in promotional materials or on the KUMC website?
Yes
No

**In the event of an emergency, if you or the emergency contact cannot be reached:

Do you give permission for the church staff to act on your behalf.
Yes
No

*Only the individuals listed below have my permission to pick up my child. (They must provide a picture ID and they must come inside the church for pickup. NO CHILD WILL BE PERMITTED TO LEAVE THE BUILDING WITHOUT BEING SIGNED OUT)*

Please include names and phone numbers:

Parent's First Name

Parent's Last Name

Address 1

Address 2

Country

City

State

Zip/Postal Code

Phone Number

Would you like to be be contacted by Kernstown United Methodist Church concerning other activities for children and families?
Yes
No

How did you hear about our VBS program?

Additional Comments:

Submit

Join us for Sunday Worship

In the Sanctuary
at 10:30 a.m.

Contact Info

3239 VALLEY PIKE
WINCHESTER, VA 22602
Phone: 540-667-7298