Vacation Bible School: June 9-13 - Gold Canyon United Methodist Church

How many children would you like to register?*

Child #1 Information

Child #1 Name*

First Last

Child #1 Gender*

Child #1 Age*

Child #1 Date of Birth*

Child #1 Last School Grade Completed*

Child #1 Allergies or other Medical Conditions?

Child #2 Name*

First Last

Child #2 Gender*

Child #2 Age*

Child #2 Date of Birth*

Child #2 Last School Grade Completed*

Child #2 Allergies or other Medical Conditions?

Child #3 Name*

First Last

Child #3 Gender*

Child #3 Age*

Child #3 Date of Birth*

Child #3 Last School Grade Completed*

Child #3 Allergies or other Medical Conditions?

Parent Name*

First Last

Home Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone*

Email Adress*

Home Church Name

Emergency Contact Name*

First Last

Emergency Contact Phone*

Relationship to child*