Bethany United Methodist Church

Home Church: *

Emergency Contact 1: *

Names of Persons who may pick up my child: *

T-Shirt Size: *

Zip Code: *

2nd Parent/Guardian's First Name:

Child's First Name: *

Cell Phone:

Evening Phone: *

Parent/Guardian's Last Name: *

Allergies/Special Needs: *

Child's Birthdate: *

Emergency Contact 2: *

Address: *

Emergency Contact 2 Phone: *

Work Phone:

2nd Parent/Guardian's Last Name:

Email: *

Parent/Guardian's First Name: *

Last Grade Completed: *

Emergency Contact 1 Phone: *

Milton, PA

Child's Last Name: *

VBS Child Registration 2018