Rock Springs United Methodist Church
Vacation Bible School
Registration
Complete one form for each child attending...thank-you
Child Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
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31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
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2003
2002
2001
2000
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1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Age
*
Last Grade
*
Please Select
Pre - K
Kindergarden
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Home Church:
Allergies, Medications and instructions:
Parent / Guardian Information
Parent/Guardian
*
First Name
Last Name
Street Address
*
Phone Number
*
-
Area Code
Phone Number
Cell Phone:
*
-
Area Code
Phone Number
E-mail
*
Emergency Contact:
Name
Phone
Emergency Contact:
Name
Phone
Emergency Contact:
Name
Phone
Name of person who may pick up this child from VBS:
Is there any other information we should know while caring for this child today ?
Submit Form
Should be Empty: