KIDS VBS REGISTRATION FORM

Plymouth Park United Methodist Church
Camp Fireflight:
June 10-14, 9am-12pm

Muggles in Training Second Semester:
August 1-2, 6pm-9pm, August 3, 9am-12pm
STUDENT REGISTRATION FORM

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

MonthDayYear
Date
Child’s Current Grade
Parent/Guardian Name(s)
Home Phone
Work Phone
Mobile
Email
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Contact Method
Siblings registered
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
My child will attend Camp Fireflight June 10-14 (Cost is $25.00 for 5 day program, includes supplies, snacks and t-shirt )*

YesNo
My child will attend Muggles in Training August 1-3 (Cost is $15.00 for 3 day program, includes supplies, snacks and t-shirt )*

YesNo
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

YesNo
Participants T-Shirt Size?

Youth SmallYouth MediumYouth LargeYouth XLAdult X-SmallAdult SmallAdult MediumAdult LargeAdult XLAdult XXL
Siblings Registered?
Is there anything you would like for us to know about your child?
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Scholarships are available. Please contact Krista Bailey, Director of Children’s Ministry at kbailey@ppumc.org
PPUMC ● 1615 West Airport Freeway ● Irving, TX ● 75062 ● ppumc.org
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Plymouth Park United Methodist Church

STUDENT REGISTRATION FORM

EMERGENCY CONTACT

DISMISSAL