Relationship to Child

Home Address

Medical Concerns

Alternate Phone Number

Age of Child

Child's Name *

Home Phone

Parents Namess

Transportation Needed?

Family Doctor

List any siblings attending VBS

Church Affiliation?

Emergency Contact Person

Contact Email: *

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Birthday *

For Vacation Bible School Activities - Click Here

List Names of Those Who May Pick Up Child

Any Food Alergies

Lewistown-Trinity UMC

Vacation Bible School at HOME

Our VBS is for Children

Ages 4 through 12

If you have any questions regarding VBS,

please call (937) 686-8755

Grade Completed *