VBS Registration Child Information Child's Name * Age/Grade Fall 2020 * 4 Y/OK12345 Gender * BoyGirlParent/Contact Information Mother's Name * Father's Name * Contact Email * This email address will be used for your conformation email. Would you like to be added to our email list for other upcoming child events? * This includes things like our Back to School Bash, Family Fall Fest, Easter Egg Hunt, Trunk or Treat and our Upward Basketball program.YesNo Address * Main Phone Number (no dash or space) * DO not add any dashes or spaces. Numbers only. 2nd Phone Number (optional)In Case of EmergencyWhen above numbers are unreachable. Emergency Contact Name * Phone Number (no dash or spaces) * Relationship * Grandmother, Grandfather, Aunt, Uncle, etcOther Important Information Is there anyone your child shouldn't be released to? * Any specific person.YesNo If yes, please list name(s) Does your child have allergies or medical concerns? * YesNo Will your child require medication while at VBS? * YesNo If yes to either question, please explain. List any allergies or medical concerns that we may need to be aware of. List any medications your child may need while at VBS. Home church * None is acceptable. One friend your child may know at VBS If dinner was offered for your child on Friday night before VBS from 5:45-6:30pm, would they be interested in attending? * YesNo By selecting this box, you are acknowledging that you have read, understand, and agree to our COVID safety plan. * I Agree *** Important *** Once submitted, you should receive a confirmation email. Please check your Junk/Spam Folder. If you do not receive this, please contact the church office at 812-637-3993 or email us at dhumcevents@gmail.com. Prev Next Submit