Register Online

VBS 2009 REGISTRATION FORM
Johnson City Primitive Methodist Church

REGISTRATION DISCLAIMER:

By completing this registration form, you hereby agree to the following:

As parent/guardian of the child(ren) listed below, I release the Johnson City Primitive Methodist Church and all volunteers associated with the Vacation Bible School program from any and all liability to the child(ren) named below during his/her/their attendance at all VBS activities. Should any injury occur, I give my permission for first aid treatment to be given and for any doctor or hospital personnel to render emergency medical treatment as is deemed necessary.

Name of Parent completing form:
Number of Children you are registering (max. 5 per online form):	1 2 3 4 5
Email Address
Mailing Address
City, State, ZIP
Street Address (if different than above)
Phone number
Transportation:	Drop-off / Pick-up Walk / Bike Church Van Requested Child coming with VBS Staff member
Emergency Contact Name (other than you):
Emergency Contact Phone (other than yours):
Names of anyone authorized to pick up child(ren):
Name of Child (1):
Gender	Boy Girl
Date of Birth
School Grade Completed
Name of Child (2):
Gender	Boy Girl
Date of Birth
School Grade Completed
Name of Child (3):
Gender	Boy Girl
Date of Birth
School Grade Completed
Name of Child (4):
Gender	Boy Girl
Date of Birth
School Grade Completed
Name of Child (5):
Gender	Boy Girl
Date of Birth
School Grade Completed
Does child(ren) currently attend church?	Yes No
If YES, where?
Has child(ren) attended VBS at Johnson City Primitive Methodist Church before?	Yes No
How did you hear about VBS 2009? (select ALL that apply)	I attend this church Referred by friend / relative VBS Website Flier from school Newspaper / Other media Mailing Yard signs at church Yard signs around area
IMPORTANT! Are there ANY food allergies and/or health concerns of which VBS Staff should be aware?	Yes No
If YES, please provide details:	captcha codes

After clicking the "Submit Form" button above, you should receive a copy of the Online Registration Form at the email address you provided. If not, please contact VBS Director by clicking:

VBS 2009 Director

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Online Registration Form provided by EmailMe Form.com - THANK YOU!

They can be accessed at the link below (will take you away from www.PMVBS.com)

email forms

www.PMVBS.com
(c) 2009 Johnson City Primitive Methodist Church

Sharing God's love in Christ to you

and through you to the world.

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VBS 2009 - Johnson City Primitive Methodist Church
Vacation Bible School - Johnson City, New York
CHRISTMAS IN JULY: Jesus is the Reason for the Season
Publisher: Johnson City Primitive Methodist Church