Aldersgate United Methodist ChurchAldersgate United Methodist ChurchAldersgate United Methodist ChurchAldersgate United Methodist Church

2206 Airfield Lane, Midland, 48642 (6312206 Airfield Lane, Midland, 48642 (6312206 Airfield Lane, Midland, 48642 (6312206 Airfield Lane, Midland, 48642 (631----1151)1151)1151)1151) -----------

Hometown Nazareth: Where Jesus was a KidHometown Nazareth: Where Jesus was a KidHometown Nazareth: Where Jesus was a KidHometown Nazareth: Where Jesus was a Kid

2015 Registration Form

June 22 - 26 5:45 pm - 8:30 pm

Family Name ____________________________________________________________________________

Address ______________________________________e-mail:_____________________________________

Phone Numbers Home __________________ Cell ___________________ Work ___________________

Children (names/grades/ages) _______________________________________________________________

_______________________________________________________________

_______________________________________________________________

Youth (names/grades/ages) __________________________________________________________________

Adults __________________________________________________________________________________

Are you attending the Adult VBS class? _____ yes _____ no

Medical and Emergency Health Care information - please complete back of this form

Dismissal Information

Name and phone number of person(s) who may pick up your child(ren) from VBS each day

________________________________________________________________________________________

________________________________________________________________________________________

How did you hear abut Vacation Bible School? _________________________________________________

If Nursery Care is needed, please call the church office

Registration with signature is required. Please download form at aumcmidland.org.

Drop-off or mail your form to the office

by Wednesday, June 17 if possible. You may also register upon arrival.

(Any questions please contact Miss. Addie Maxwell: 708-1758 or akdmax67@gmail.com)

Photo Release: I also give permission for photographs, video and/or audio recordings to be used for publicity,

including the Internet, for Aldersgate UMC Ministries.

_____________________________________________ ____________________

Parent/Guardian Signature Date

Medical Information: Name of Insurance Carrier _____________________________________________

Insurance Group Number __________________________ Policy Number _____________________________

Does participant have any food allergies, physical, mental, or medical issues that staff paid or volunteers should

be made aware of? Yes or No (please circle)

If yes, please explain ________________________________________________________________________

(please use bottom of this form for additional information)

I understand that safety precautions will be taken by the church and its agents during this event. However, I un-

derstand that the possibility of injuries, unforeseen hazards and inherent risks exists. I agree not to hold the

Church, its employees, members and volunteers liable for and I release them from any damage, losses, diseas-

es, or injuries incurred by the participant.

Emergency Health Care: I authorize any emergency health care or treatment for my child, youth or

vulnerable person that is deemed necessary by the Aldersgate Hometown Nazareth Vacation Bible School

event coordinator. A prompt call will be made to the emergency contact numbers provided below.

Emergency Contact Numbers _____________________________ or _________________________________

Relationship

Parent/Guardian Last Name ________________________ First______________to participant_____________

Signature of Parent or Guardian _________________________________________ Date _________________