WORTHINGTON UNITED METHODIST CHURCH
614-885-5365
Worthington United Methodist Church
600 High Street
Worthington, OH 43085
614-885-5365
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Explorations
VBS 2011: Shake It Up Cafe!!
form in .pdf
July 25 through July 29, 2011 5:30-8:30 pm
CostsS: $20 / child (including family dinner each night and a T-shirt) or $40.00 per family, max.
Childs Information
Child's Name
T-Shirt Size
Childs: sm
med
- lrg
or
Adults: sm
- med
- lrg
- xlrg
Grade
Completed
in June 2011
:
Current Age
:
Allergies
:
YES
NO
If YES Type of Allergy
:
2nd Childs Information
Child's Name
T-Shirt Size
Childs: sm
med
- lrg
or
Adults: sm
- med
- lrg
- xlrg
Grade
Completed
in June 2011
:
Current Age
:
Allergies
:
YES
NO
If YES Type of Allergy
:
3rd Childs Information
Child's Name
T-Shirt Size
Childs: sm
med
- lrg
or
Adults: sm
- med
- lrg
- xlrg
Grade
Completed
in June 2011
:
Current Age
:
Allergies
:
YES
NO
If YES Type of Allergy
:
4th Childs Information
Child's Name
T-Shirt Size
Childs: sm
med
- lrg
or
Adults: sm
- med
- lrg
- xlrg
Grade
Completed
in June 2011
:
Current Age
:
Allergies
:
YES
NO
If YES Type of Allergy
:
Medical Information
Other Medical Information of which we should be aware
:
Parent Information
Parent / Guardian Name
:
Address
:
(line 2)
City
:
Zip
:
Phone
:
Cell Phone
:
Email
:
Other Contact Information
In case we are unable to reach you:
Contact Name
:
Phone
:
Cell Phone
:
Relationship to child
:
Costs: $20 / child (including family dinner each night and a T-shirt) or $40.00 per family, max.
Amount Owed: $
(Make checks payable to WUMC w/VBS in memo.)
Number attending family dinner each night:
How did you hear about VBS 2011 at Worthington UMC? please circle one:
Church
Memorial Day parade
Friend/Relative
Other