Child Information

One child per form. Thanks. ;-)

Child First Name   Child Last Name

Child's Date of Birth (mm/dd/yyyy)

The grade last completed:   K 1  2 3 4  5 6 (Select one)
(Your child must be 4 years old by July 1, 2010 to attend VBS)

Does your child have any special needs or allergies, etc.?
 

Please Note: Each child must have a Medical Release/Waiver form completed and signed by a parent on file at the church BEFORE your child can attend VBS or any activity at FUMC. Download and print the file, fill it out, sign it and mail it before July 1, 2010 to:

VBS Medical Release
Attention: Joy Turner
First United Methodist Church
211 W. Third Street
Irving, TX 75060

Note: You can also bring it to the church office. 

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Parent  Information

Parent's / Guardian's Name(s)

    Parent Street Address & Number  

Parent City   Parent Zip Code

 Parent Home Phone #     Parent Other Phone #

 Parent Cell Phone #     Parent Work Phone #

Picking Up Your Child

Who will be picking your child up?  Parent/Guardian Above Other
If you selected 'Other' please fill out the information below for the person picking up your child.

PARENTS! Because of SAFETY AND SECURITY ISSUES, we ask that PARENTS themselves, not older siblings, or Responsible designated adult pickup children from VBS. Your child's safety is our utmost concern.

Pickup  Name

    Pickup Street Address & Number  

Pickup City   Pickup Zip Code

 Pickup Home Phone #     Pickup Cell Phone #
 

Alternate Emergency Contact Person

Contact Name

  Contact Street Address & Number  

Contact City   Contact Zip Code

 Contact Home Phone #     Contact Email Address

Photo Waiver

Photos will be taken during VBS of the children enjoying activities. These may be posted on the church website or used to promote VBS, and also will be part of the slide show at the closing program on Friday evening. Your child’s name or other information will NOT be published, only photos. May we have your permission to use your child’s photo?

Yes    No

Optional Questions

Do you have a Church that you attend regularly?   Yes   No

What church is that? 

Would you like more information from FUMC-Irving?   Yes   No