2009

VBS Registration Form

August 3-7

Registration fee is $10/child with a cap of $30/family. Make checks payable to “MFC” and note “VBS” on the memo line. Please include an e-mail address, if possible, as it is the most efficient way to get in touch with you. Thank you!

Parent/Guardian Name: __________________________________________________________

Address: _____________________________________________________________________

Home Phone: __________________________ Work/Cell Phone: _______________________

E-mail address: ________________________________________________________________

Church Member? ______ Name of Your Church _____________________________________

Would you like more information about this Church? __________________________________

Emergency Contact: ________________________________ Phone: _____________________

Child’s Name: _________________________________________________________________

Date of Birth: ________________ Age: _______________ Grade in Fall: ________________

Allergies or other concerns: ______________________________________________________

Special requests for placement (we will try to honor these but cannot guarantee it): __________
______________________________________________________________________________

Child’s Name: _________________________________________________________________

Date of Birth: ________________ Age: _______________ Grade in Fall: ________________

Allergies or other concerns: ______________________________________________________

Special requests for placement (we will try to honor these but cannot guarantee it): __________
______________________________________________________________________________

Child’s Name: _________________________________________________________________

Date of Birth: ________________ Age: _______________ Grade in Fall: ________________

Allergies or other concerns: ______________________________________________________

Special requests for placement (we will try to honor these but cannot guarantee it): __________
______________________________________________________________________________

Child’s Name: _________________________________________________________________

Date of Birth: ________________ Age: _______________ Grade in Fall: ________________

Allergies or other concerns: ______________________________________________________

Special requests for placement (we will try to honor these but cannot guarantee it): __________
______________________________________________________________________________

Please see the reverse side to volunteer to help in some capacity with VBS. Thank you.

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For Church use only:

Amount paid: __________________ Cash _____________ Check No. ___________________