2025 Vacation Bible School, First UMC Belle Vernon

Form
2025 Vacation Bible School
Name (Child 1)*

First NameLast Name
Current Grade*
Birth Date*
Age*
Name (Child 2)

First NameLast Name
Current Grade
Birth Date
Age
Name (Child 3)

First NameLast Name
Current Grade
Birth Date
Age
Name (Child 4

First NameLast Name
Current Grade
Birth Date
Age
Name (Child 5)

First NameLast Name
Current Grade
Birth Date
Age
Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Email*
example@example.com
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IN THE EVENT OF AN EMERGENCY, I authorize FUMC Church to contact the following people. If I am unable to pick up my child, I give permission for the following people to pick up my child. I will inform them that I have listed them as emergency contacts.
Emergency Contact 1*

First NameLast Name
Home Phone Number*
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Emergency Contact 2

First NameLast Name
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Emergency Contact 3

First NameLast Name
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Please check boxes to show permission given
I hereby give permission for my child to attend and participate in Belle Vernon First United Methodist Church's (FUMC) Vacation Bible School Program*

Click to agree.
I give permission for emergency medical treatment necessary in the event of accident or illness during Vacation Bible School at Belle Vernon First United Methodist Church. I release FUMC and its people from liability in case of accident. I expect to be contacted if medical attention is necessary.*

Click to agree.
***Special Needs/Allergies (List any additional medical information below).
Media Release
I give permission for photos to be taken of my child while attending FUMC's Vacation Bible School*

Click to agree.
I give permission for photos of my child to be used on FUMC's website. Names will not be used in conjunction with the photos.*

Click to agree.
Should be Empty:

Form

2025 Vacation Bible School

Parent/Guardian Information

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Please check boxes to show permission given

Media Release