To Mars and Beyond! VBS 2019
 
To Mars and Beyond! VBS 2019
The cost for attending Workshop of Wonders VBS is $10 per child or $20 for a family (up to 4). How many children will be attending? Choose number below.  * 
SECTION ONE: FIRST Child Information
FIRST CHILD: First & Last Name  * 
FIRST CHILD: Choose your child’s age from the list: (children under 4 require pre-approval)  * 
FIRST CHILD: Choose the grade your child will be entering in Fall 2019:  * 
FIRST CHILD: List any known allergies to medication, environment or food and child's reaction. (Please answer "NONE" if there are none.) * 
FIRST CHILD: List any medical issues we should be aware of. (Please answer "NONE" if there are none.) * 
SECTION 2: The next section pertains to families with MORE THAN ONE CHILD attending VBS. If you only have one child attending, please skip to SECTION 3.
SECOND CHILD: First & Last Name
SECOND CHILD: Choose your child's age from the list:
SECOND CHILD: Choose the grade your child will be entering in Fall 2019:
SECOND CHILD: List any known allergies to medication, environment or food and child's reaction. (Please answer "NONE" if there are none.)
SECOND CHILD: List any medical issues we should be aware of. (Please answer "NONE" if there are none.)
THIRD CHILD: First & Last Name
THIRD CHILD: Choose your child's age from the list:
THIRD CHILD: Choose the grade your child will be entering in Fall 2019:
THIRD CHILD: List any known allergies to medication, environment or food and child's reaction. (Please answer "NONE" if there are none.)
THIRD CHILD: List any medical issues we should be aware of. (Please answer "NONE" if there are none.)
FOURTH CHILD: First & Last Name
FOURTH CHILD: Choose your child's age from the list:
FOURTH CHILD: Choose the grade your child will be entering in Fall 2019:
FOURTH CHILD: List any known allergies to medication, environment or food and child's reaction. (Please answer "NONE" if there are none.)
FOURTH CHILD: List any medical issues we should be aware of. (Please answer "NONE" if there are none.)
Your Email Address  * 
SECTION THREE: Parent Information & Emergency Contacts
Parent(s) First & Last Name(s)  * 
Address  * 
City  * 
State  * 
Zip  * 
Main Phone  * 
Secondary Phone
Work Phone
E-mail Address  * 
Church Affiliation
Primary Emergency Contact Name  * 
Primary Emergency Contact Phone Number  * 
Secondary Emergency Contact Name
Secondary Emergency Contact Phone Number
Name of Authorized Adult who may pick up child(ren)  * 
Phone Number of Authorized Adult who may pick up child(ren)  * 
Name of Authorized Adult who may pick up child(ren)
Phone Number of Authorized Adult who may pick up child(ren)
ADDITIONAL INFORMATION: BATHROOM DUTY: Children 4 years and over will be walked to the bathroom and a volunteer will stand near the outside door of the bathroom. Children will not be assisted with toileting inside the stall, so please prepare your child. OUTDOOR ACTIVITIES : Children participate in recreation and crafts to be held outdoors each day. We strongly recommend you apply sun block to your child prior to arriving. If you think it necessary for you or your child to have insect repellant, please also apply this prior to arriving.
PERMISSION:I hereby give permission for my child(ren) to attend the community Vacation Bible School at Whitefish United Methodist Church located at 1150 Wisconsin Avenue. I will not hold Whitefish United Methodist Church or individual staff/counselors liable for such accident or injuries which might occur during the Community VBS. I understand that in the event of an emergency, every effort will be made to notify me; however, in the event I can not be reached, I authorize whatever emergency procedures might be deemed necessary. I authorize Community VBS medical volunteers to administer the medication noted above on this form. Any reservations I might have concerning this release, or any allergies/special issues are noted above on this form.
I AGREE with the above statement as my legal signature of release.  * 
PHOTO RELEASE: Staff and volunteers at Whitefish United Methodist church will be taking photos of the children during the Community VBS. These photos are typically used on our church website and in our newsletter without identifying children by name. Local media may also visit and cover the Community VBS. I hereby give my consent to Whitefish United Methodist Church to photograph my child(ren) and without limitation, to use such photos and or/stories in connection with any of the work of said Community VBS program without consideration of any kind and do hereby release Whitefish United Methodist Church and those represented in the Community VBS from any claims whatsoever which may arise in said regard.
I AGREE with the above statement as my legal signature of release.  * 
For questions or more information, e-mail: Erin Adams-Griffin at erinraeag@gmail.com or contact the WUMC office at 406.862.3418 / office@whitefishumc.org
Total $
 
 
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