VBS Registration Form

Northglenn United M‍‍‍ethodist Church

1605 West 106th Avenue, Northglenn, CO  80234

June 25 - 29, 2018

Child's Name (One per child):____________________________________________

Parent/Family/Guardian Name:_________________________________

Address: ______________________________________________

E-mail Address:__________________________________________

Phone Numbers - Home: ____________   Cell: ____________    Work:____________

Age Information- Date of birth: _____________   Age:_____________

Last school grade completed: ______________

Home Church: ____________________________________________________

Friends of your child at this church: _______________________________________

Special Needs/Allergies/Medical Information/Other: _____________________________

_____________________________________________________________
Emergency Contacts

Name: ‍‍____________________________________________

Phone: ______________________________

Name: ____________________________________________

Phone: __________________________________

Dismissal Information

Name(s) of person(s) who may pick up this child from VBS: _____________________________________________________________

Other Information (church use only):

Rafter Group: ________________________________________

Are parents/guardians/family members helping with Rolling River Rampage? ___________

If yes, where? _____________________________________________________

** You may bring form to NUMC, email Elaine at [email protected] or fax:  303-452-0574