Alesia Free Methodist Church: VBS 2017 Registration

Thank you for filling out this registration form completely. This information will help us ensure the best possible experience for your child.

Your Child's Information

Full Name:

Nickname (if any):

Sex:

Male

Female

Date of Birth

Grade Level (as of Fall 2017):

Street Address (including City, State, & ZIP code):

Allergies/Medications:

Parent/Legal Guardian Information

Parent/Legal Guardian #1

Full Name:

Email:

Home Phone:

Cell Phone:

Parent/Legal Guardian #2

Full Name:

Email:

Home Phone:

Cell Phone:

Parent/Legal Guardian #3

Full Name:

Email:

Home Phone:

Cell Phone:

Emergency Contact Information

Full Name:

Phone Number:

Relationship to Child:

Other Information:

If someone not named on this form needs to pick up your child from VBS, please call Pastor Richard Reilly at (410) 596-5801 to let him know.

Positive SSL