Batavia United Methodist Church

Vacation Bible School Registration

When: July 27 - 31, 9am – noon
Who: Children age four (as of 9/1/09) through rising fifth graders (Children must be
potty-trained)
Cost: $20 per child;
Three or more per family:
$50 total

REGISTRATION DEADLINE IS July 12.

FORMS RECEIVED AFTER July 12 WILL INCURE A $5 LATE FEE.
REGISTRATION IS NOT COMPLETE UNTIL SIGNED FORM AND FEE IS SUBMITTED.

Child’s Name: ____________________________________________ Age: ____________

Date of Birth: ____________________________________ Grade for fall ’09: _____________

Street Address: ________________________________ City: ___________________________

Parent/Guardian: _______________________________________________________________

Home phone: _______________________Work/Cell phone: ___________________________

Emergency Contact(s): (other than parents/guardian)

Name: ___________________________ Phone: _____________________

Name: ___________________________ Phone: _____________________
Physician: _______________________ Phone: _____________________

Allergies/Physical/Dietary Concerns: _______________________________________________

To further enhance this family approach, we are encouraging parents/guardians to join their
child(ren)’s tribe during the week. Please indicate which days you plan to visit Camp Edge:

_____ Monday _____ Wednesday _____ Friday

_____ Tuesday _____ Thursday

Child’s Home Church: _________________________________

(Over please!)
OTHER: VBS t-shirts and a CD of the music the children will learn during VBS are available for
purchase. If you would like to purchase either or both items, please indicate on the “Registration
Checklist” below. These items are OPTIONAL.

PLEASE MARK YOUR CALENDARS: An ice cream social is scheduled for Thursday, July 30, for
all VBS participants and their families. Please plan to join us as we celebrate with our “Camp
Edge.”

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In the event of an emergency, we will attempt to contact you. If we are unable to reach you,
your signature below indicates that you grant the Director of Christian Education, or her designee,
permission to seek medical treatment for your child and indicates your consent for your child to
receive any medical treatment deemed necessary by the examining physician. It further indicates
that you have full financial responsibility for any such care.

I also give permission for my child to be photographed by Batavia United Methodist Church for a
closing program slide show and promotional photos for future Bible schools.

Parent/Guardian: __________________________________________

REGISTRATION CHECKLIST
Registration $20.00 $
T-shirt $10.00
$
Circle size XS S M L XL

CD (optional) $5.00 $
TOTAL
(Make checks payable to Batavia UMC – VBS in Memo) $

Registration Fee paid _________