VBS Registration

Children

Please register all your children on one form.

Child 1

Child 1 Name *

Child 1 Date of Birth *

Child 1 Last Grade in School *

Child 1 T-Shirt Size *

Child 2

Child 2 Name

Child 2 Date of Birth

Child 2 Last Grade in School

Child 2 T-Shirt Size

Child 3

Child 3 Name

Child 3 Date of Birth

Child 3 Last Grade in School

Child 3 T-Shirt Size

Child 4

Child 4 Name

Child 4 Date of Birth

Child 4 Last Grade in School

Child 4 T-Shirt Size (copy)

Contact Information

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent Email *

Parent Phone *

Home Church

Photo Release *

I give permission for my child (children) to be photographed.
I do not give permission for my child(children) to be photographed

Medical Information

Please add if there are allergies or medical conditions. Write none across if there aren’t any!

Child 1

Child's Name

Allergies or Other Medical Conditions

Child 2

Child's Name

Allergies or Other Medical Conditions

Child 3

Child's Name

Allergies or Other Medical Conditions

Child 4

Child's Name

Allergies or Other Medical Conditions

Emergency Contact

In Case of Emergency, Contact

Phone

Relationship to Child(ren)

All Information will be sent to Wentz’s United Church of Christ

Please contact the church office with any questions.

610-584-4855
office@wentzsucc.org

Please fill out the form below or download the printable PDF here and mail or email it to the church.

Children

Contact Information

Medical Information

Emergency Contact

All Information will be sent to Wentz’s United Church of Christ