Camp Firelight VBS Registration

* Indicates required field

Child's Name *

First

Last

Parent/Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Home Phone Number *

Cell Phone Number *

Age *

Last School Grade Completed *

Home Church *

Special Needs/Allergies *

Emergency Contact Name *

First

Last

Name of Person(s) who may pick up child *

Emergency Contact Phone Number *

Photo Release
Arbutus United Methodist Church has my permission to use my child's photograph publicly in materials. I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.

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