VBS Registration Form

  For EACH child, please print both our VBS forms: registration & medical release below

Please complete and return them to the church office, in person or by mail to:    

Manchester Church of the Brethren  P.O. Box 349, North Manchester, IN  46962 

 ~ ~ Thank you!  

 

Marketplace 29 A.D.

Vacation Bible School

June 12-15, 2017 ~~ 5:15 – 8 p.m.

Manchester Church of the Brethren

1306 N. Beckley Street

Mailing Address:  P.O. Box 349, North Manchester

Phone:  982-7523

 

Children are invited to experience and learn about life

as it was in Jesus’ day through nightly Bible Stories, Songs, Games,

and a variety of Crafts and Foods available in the Marketplace tent.

A light meal will be served each evening.

Children ages 3 years old through finishing 5th grade are welcome!

To register, please complete the form below and return it to the church office.

 

DEADLINE TO REGISTER – Monday, May 29

 

************************************************************************

 

Name_____________________________________  M____  F____  Age_________

Address____________________________________________________________

                  Street                                                   City                                 State                   Zip

 

Phone_____________________ Birth Date_____________    Grade Completed________

 

In Case of Emergency, Contact:

Parent/Guardian________________________________  Phone_____________________

Parent/Guardian________________________________  Phone_____________________

Other________________________________________  Phone_____________________

                                        (Relative or Friend)

Allergies or conditions which may limit activities: __________________________________

_______________________________________________________________________

  I would like to help. Please contact me.   

Name ________________________________________ Phone___________________                         

  **************************************************************** 

                                                                                 MEDICAL RELEASE FORM

(right click then print)
or click this link to the pdf Medical Form
 

               Child's Name:_______________________________

             Parent/Guardian emergency cell phone#_______________________________

          Physician's Name_____________________________ Phone ______________

If an emergency need should arise, I hereby give my permission for the Manchester Church of the Brethren personnel to obtain care for my child from  a licensed physician. 
I also give permission for my child to be taken to a medical facility. 
If I cannot be contacted, I authorize the administration of the Manchester Church of the Brethren to act in my behalf, relative to emergency,  in obtaining medical treatment for my child.   

 

Signature of Parent/Guardian:  ____________________________ Date: ___________