KIDS VBS REGISTRATION FORM

Plymouth Park United Methodist Church
Jedi Faith Alliance: August 4-5, 6 p.m. – 9 p.m. August 6, 9 a.m. – 12 p.m.
STUDENT REGISTRATION FORM

Director Contact: Krista Bailey, (972) 255-4185 or kbailey@ppumc.org
Child’s Name
Child’s Age
Child’s Birth Date

Month Day Year
Date
Child’s Current Grade
Parent/Guardian Name(s)
Home Phone
Work Phone
Mobile
Email
example@example.com
Preferred Contact Method
EMERGENCY CONTACT
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor
Phone
Allergies or Special Needs
DISMISSAL
Who may pick up your child at the end of each VBS day?
Name
Relationship
Name
Relationship
Parent/Guardian Signature

Clear
Date

Month Day Year
Date
PPUMC ● 1615 West Airport Freeway ● Irving, TX ● 75062 ● ppumc.org
Child’s Name
PHOTO RELEASE: Can your child be photographed, and the pictures appear in church news articles in print and on the internet/social media? (Circle one) Yes No

Yes No
Participants T-Shirt Size?

Youth Small Youth Medium Youth Large Youth XL Adult X-Small Adult Small Adult Medium Adult Large Adult XL Adult XXL
Siblings registered
Is there anything you would like for us to know about your child?
My child will attend Jedi Faith Alliance August 4-6 (Cost is $15.00 for 3 day program, includes supplies, snacks and t-shirt )

Yes No
Scholarships are available. Please contact Krista Bailey, Director of Children’s Ministry at kbailey@ppumc.org
Should be Empty:

Plymouth Park United Methodist Church