Clone of Central UMC "Live it Out" VBS Registration Form

Central UMC "Operation Restoration" 2026 VBS Registration Form

5:15pm-7:30pm June 7-June 10 for ages 3-11. A family meal will be served 5:15-5:45pm. Central UMC, 200 E. Marion St. Shelby, NC. Contact caroline@cumcshelby.org with any questions.
STUDENT INFORMATION
Child Name*

First NameLast Name
Birthdate *

MonthDayYear
Date
Grade completed *
T-shirt Size
Would you like to register another child?*

YesNo

Additional Child Name

First NameLast Name
Birthdate

MonthDayYear
Date
Grade completed
T-shirt Size
Another Additional Child Name

First NameLast Name
Birthdate

MonthDayYear
Date
Grade completed
T-shirt Size
Please click next to continue registration...

Household Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Adult Contact Name*
Primary Adult Phone Number*
Please enter a valid phone number.
Primary Adult Email*
example@example.com
Secondary Adult Contact Name
Secondary Adult Phone Number
Please enter a valid phone number.
Secondary Adult Email
example@example.com
EMERGENCY CONTACT
Emergency Contact Name*
Relationship to child*
Emergency Contact Number*
AUTHORIZED PICKUP ADULTS

Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people unless notification has been given to the church office or Caroline Scism.
Authorized Pickup #1 Name*
Relationship to child*
Authorized Pickup #1 Phone Number*
Authorized Pickup #2 Name
Relationship to child
Authorized Pickup #2 Phone Number
Medical Information
Please list any allergies for your child/children -- or type "none" if there are none*
Does your child/children carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)*

YesNo
Please list any other medical concerns for your child/children
Additional Information
Photos/videos are taken for promotional purposes related to Central UMC and Vacation Bible School. These pictures appear in various media outlets such as the Weekly Newsletter and our Facebook & Instagram pages and webpage. Do you allow your child/children to be included in these photos/videos?*

YesNo
A family meal will be served 5:15-5:45 before VBS Opening Worship. Parents/Guardians are welcome to eat together as a family before VBS Opening Worship. How many members of your family (children and adults) do you expect to attend the family meal?
Is there any additional helpful information we should know?
Should be Empty:

Central UMC "Operation Restoration" 2026 VBS Registration Form

Medical Information

Additional Information