aldersgate united methodist churchaldersgate united ......aldersgate united methodist...
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Aldersgate United Methodist ChurchAldersgate United Methodist ChurchAldersgate United Methodist ChurchAldersgate United Methodist Church
2206 Airfield Lane, Midland, 48642 (6312206 Airfield Lane, Midland, 48642 (6312206 Airfield Lane, Midland, 48642 (6312206 Airfield Lane, Midland, 48642 (631----1151)1151)1151)1151) -----------
Hometown Nazareth: Where Jesus was a KidHometown Nazareth: Where Jesus was a KidHometown Nazareth: Where Jesus was a KidHometown Nazareth: Where Jesus was a Kid
2015 Registration Form
June 22 - 26 5:45 pm - 8:30 pm
Family Name ____________________________________________________________________________
Address ______________________________________e-mail:_____________________________________
Phone Numbers Home __________________ Cell ___________________ Work ___________________
Children (names/grades/ages) _______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Youth (names/grades/ages) __________________________________________________________________
Adults __________________________________________________________________________________
Are you attending the Adult VBS class? _____ yes _____ no
Medical and Emergency Health Care information - please complete back of this form
Dismissal Information
Name and phone number of person(s) who may pick up your child(ren) from VBS each day
________________________________________________________________________________________
________________________________________________________________________________________
How did you hear abut Vacation Bible School? _________________________________________________
If Nursery Care is needed, please call the church office
Registration with signature is required. Please download form at aumcmidland.org.
Drop-off or mail your form to the office
by Wednesday, June 17 if possible. You may also register upon arrival.
(Any questions please contact Miss. Addie Maxwell: 708-1758 or [email protected])
Photo Release: I also give permission for photographs, video and/or audio recordings to be used for publicity,
including the Internet, for Aldersgate UMC Ministries.
_____________________________________________ ____________________
Parent/Guardian Signature Date
Medical Information: Name of Insurance Carrier _____________________________________________
Insurance Group Number __________________________ Policy Number _____________________________
Does participant have any food allergies, physical, mental, or medical issues that staff paid or volunteers should
be made aware of? Yes or No (please circle)
If yes, please explain ________________________________________________________________________
(please use bottom of this form for additional information)
I understand that safety precautions will be taken by the church and its agents during this event. However, I un-
derstand that the possibility of injuries, unforeseen hazards and inherent risks exists. I agree not to hold the
Church, its employees, members and volunteers liable for and I release them from any damage, losses, diseas-
es, or injuries incurred by the participant.
Emergency Health Care: I authorize any emergency health care or treatment for my child, youth or
vulnerable person that is deemed necessary by the Aldersgate Hometown Nazareth Vacation Bible School
event coordinator. A prompt call will be made to the emergency contact numbers provided below.
Emergency Contact Numbers _____________________________ or _________________________________
Relationship
Parent/Guardian Last Name ________________________ First______________to participant_____________
Signature of Parent or Guardian _________________________________________ Date _________________