Grade Completed *

Medical Concerns

Alternate Phone Number

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Family Doctor

List any siblings attending VBS

List Names of Those Who May Pick Up Child

Church Affiliation?

Any Food Alergies

Emergency Contact Person

Contact Email: *

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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

Relationship to Child

Home Address

Age of Child

Child's Name *

Home Phone

Parents Namess

Transportation Needed?

Birthday *