Relationship to Child

Home Address

Age of Child

Child's Name *

Home Phone

Parents Namess

Birthday *

Family Doctor

List Names of Those Who May Pick Up Child

You May Also Enter Your Child ONLINE (see below)

If you have more than one child attending, please submit one child's information per form.

Church Affiliation?

Any Food Alergies

Emergency Contact Person

Contact Email: *

Check here to receive email updates

Grade Completed *

Medical Concerns

Alternate Phone Number

Transportation Needed?

List any siblings attending VBS

Lewistown-Trinity UMC

Vacation Bible School

Our VBS is for Children

Ages 4 through 12

If you have any questions regarding VBS,

please call (937) 686-8755