VBS Registration Form

 

Please complete the form below

Child's Name *
Child's Name
One registration per child, if you are registering multiple children please submit a separate form.
Select the grade that the child will be entering this upcoming year.
Parent's Name *
Parent's Name
Address *
Address
Primary Number *
Primary Number
Secondary Number
Secondary Number
Emergency Contact *
Emergency Contact
Emergency Contact Number *
Emergency Contact Number
If your child has any food allergies, please list them here.
If your child takes any medication, please list them here.
Primary Physician Number
Primary Physician Number
Consent to Administer Emergency First Aid or Medical Treatment *
Please read through the entire statement below regarding consent for emergency first aid or medical treatment. In the unlikely event of illness or accident I give permission for any necessary emergency first aid or medical treatment to be given. In an emergency and if I am not contactable, I am willing for my child to receive hospital treatment. I understand that every reasonable effort will be made to contact me as soon as possible. By checking the box below, you are agreeing or disagreeing to the above statement.
Consent to Release Photos *
Please read through the entire statement below and decide whether or not to consent to release photos. Occasionally, Cedar Lake United Methodist Church, CLUMC, uses photographs of children and youth to print publications such as newsletters, Facebook, etc. By checking the box below, you are agreeing or disagreeing to the above statement.