Shepherdstown United Methodist Church
Saturday, March 23, 2019

Vacation Bible School Online Request Page

Child’s Name:    
Street Address:      City:   
                 State:     ZIP:                        
              Age:                                                                   Date of birth: 
 School grade completed as of June 20, 2019:

 Home church:  

 Name of a special friend your child might like to be with: 
Roar Crew Number(for church use only): _______________________
Parental / Guardian Information:
Name of Parent(s)/Guardian:         Phone Number:    
                       Cell Number:       
E-Mail Address:  
Emergency Contact Name & Phone Number: 
Parental Authorization  
You will receive a numbered token when your child registers during the first night of Bible School. The number on the token will correspond with a number of your child’s nametag. If you will not be picking up your child, please give the token to the adult who will be. If a token is not presented, we will use the following list to make sure that your child is with a person who has your permission to pick them up. 
The following have my permission to pick up my child:
1.            2. 

3.            4. 
Health Information:
 Please list any allergies, medications, and/or special instructions: 
I also authorize the VBS staff or designated medical professionals to administer emergency medical assistance should it become necessary, understanding that I will be contacted immediately in such an event. In the event that someone cannot be reached in an emergency, I hereby authorize the physician selected by the church to secure proper treatment necessary for my child named above. I accept responsibility for payment of expenses incurred as a result of medical treatment. 
Please Type AGREE in the box to confirm your acceptance of the above statement:  
Note: Your Child will not be registered  unless the above statement is accepted.  We will also require a signature on the first night your child attends.    Signature of Parent or Guardian
     Shepherdstown UMC may photograph/video my child during VBS.  These images will not be posted online.  They may be used in crafts, given to a child for a keepsake, used during worship and VBS slide shows and for bulletin board use within the church.  Names will not be displayed with photos without permission.  By checking YES, you release all claims against SUMC with respect to copyright ownership and publication including any claim for compensation related to use of the materials.
Light meals will be available for children and adults from 5:00-5:45 in the Fellowship Hall. Please indicate below which days you are planning to join us by writing(on the line) number of people attending.  There will be no meal offered on Sunday night.  Children must always be accompanied by an adult! 
        Number Attending                                                                                                                                                Number Needing Gluten Free Food Option
      Monday –  Mack-aroni and Cheese with Hooper's Hot Dogs                                 
      Tuesday –  Marge's Marvelous Burgers and Jambo-licious Fries                            
      Wednesday -  Zion's Chicken Corn Noodle Soup with Zesty Grilled Cheese              
      Thursday –  Savannah's Super Sumptuous Pizza                                                  
All meals are $3.00 for ages 6 - adult and $2.50 for 1-5 year olds.  Each meal will include a drink and dessert.  Peanut butter and Jelly will also be available.
Incomplete forms will not be registered and held for completion.