Coldspring Methodist Church
VACATION BIBLE SCHOOL

JUNE 26-30, 2023

5:30 – 8:30p.m.

Ages 5 through 6th grade

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Child's Name

First

Last

Checkboxes

Age and Next Year's Grade in School

Parent/Guardian:

List persons who may pick up child:

Sibling 1

First

Last

Checkboxes (copy)

Age and Next Year's Grade in School (copy) (copy)

Sibling 2

First

Last

Checkboxes (copy) (copy)

Age and Next Year's Grade in School (copy) (copy) (copy)

Conditions which may limit activity:

Any food, insect or other allergies?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone

Other phone

Emergency Contact Person

First

Last

Emergency Contact Phone

Emergency Contact Relationship to Child

Home Church (if applicable)

Coldspring Methodist ChurchVACATION BIBLE SCHOOL