VBS Registration - Ebenezer United Methodist Church

Summer Camp Registration

Child: Last Name

Child: First Name

Grade

Age

(#'s 3-12)

Date of Birth- mm/dd/yyyy

Address

City

State

ZIP

Email

Home Phone

Cell Phone

Allergies/Special Instructions

Father/Guardian Name

Mother/Guardian Name

Father/Guardian Email

Mother/Guardian Email

Father/Guardian Cell

Mother/Guardian Cell

Emergency Contact

Emergency Contact 2

Emergency Phone

Emergency Phone 2

Church (If you regularly attend church, which one?)

Wk 1: Jun 11-15

Wk 5: Jul 9-13

Wk 9: Aug 6-10

Wk 2: Jun 18-22

Wk 6: Jul 16-20

Wk 10: Aug 13-17

Wk 3: Jun 25-29

Wk 7: Jul 23-27

Wk 11: Aug 20-24

Wk 4: Jul 2-6

Wk 8: Jul 30-Aug 3