2025 VBS Registration
Register your child for VBS fun at Polk City United Methodist Church!
Name of Parent/Guardian #1
*
Email
*
This address will receive a confirmation email
Phone
*
Address
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YT
Parent/Guardian #1, Are you willing to volunteer?
*
Please select one option.
Yes!
Sorry, I am unable at this time
If Yes, what role would you prefer?
Please select all that apply.
Station Leader/Helper: Stay at a planned station and lead children as they cycle through.
Group Leader: Lead a group of chlidren from station to station.
Other
Name of Parent/Guardian #2
Phone
Email
This address will receive a confirmation email
Parent/Guardian #2, Are you willing to volunteer?
Please select one option.
Yes!
Sorry, I am unable at this time
If Yes, what role would you prefer?
Please select all that apply.
Station Leader/Helper: Stay at a planned station and lead children as they cycle through.
Group Leader: Lead a group of chlidren from station to station.
Other
Child 1
Child's Name
*
Child's Date of Birth
*
Child's Grade for 24/25 School Year
*
List any food, drug, or other allergies. Note if epi-pen is carried. (If none, say none)
*
Shirt size:
*
Please select all that apply.
Youth- S
Youth - M
Youth - L
Adult - S
Child 2
Child's Name
Child's Date of Birth
Child's Grade for 24/25 School Year
Please list any food, drug, or other allergies. Please note if epi-pen is carried.
Shirt Size
Please select all that apply.
Youth - S
Youth - M
Youth - L
Adult - S
Child 3
Child's Name
Child's Date of Birth
Child's Grade for 24/25 School Year
Please list any food, drug, or other allergies. Please note if epi-pen is carried.
Shirt Size
Please select all that apply.
Youth - S
Youth - M
Youth - L
Adult - S
Child 4
Child's Name
Child's Date of Birth
Child's Grade for 24/25 School Year
Please list any food, drug, or other allergies. Please note if epi-pen is carried.
Shirt Size
Please select all that apply.
Youth - S
Youth - M
Youth - L
Adult - S
Emergency Contact and Medical Information
In the event of an emergency all efforts will be made to contact the parent/guardian of the child. In the event the parent/guardian cannot be contacted, the following person(s) will be contacted.
Name and phone number of Non-Parent/Guardian Emergency Contact #1
*
Name and phone number of Non-Parent/Guardian Emergency Contact #2
*
Consent
Please provide your electronic signature to indicate your agreement with the following statements.
I have legal custody of the student(s) named, a minor, and am giving my consent for him/her to attend events organized by Polk City UMC. I understand there are risks involved in any event and I hereby release Polk City UMC, its pastor, employees, and volunteers from any and all liability for any injury, loss, or damage to a person or property during the course of my child's involvement with the organization. (Type electronic signature indicating agreement.)
*
In the event my child is injured and requires medical attention, I hereby give consent to any reasonable medical treatment as deemed necessary by a licensed medical professional. In the event that treatment is required from a licensed physician or hospital personnel, I agree to hold such person free and harmless of any claims of responsibility for the cost of any medical care not reimbursed by my insurance provider. (Type electronic signature indicating agreement.)
*
Occasionally the church takes photos and videos during events for use on official church social media account, newsletters, and/or website. Please check the box indicating your consent to have your child's photo posted on these official platforms only.
*
Please select one option.
Yes, it is ok to include my child's photo in official church platforms.
My child's photo may be used internally (e.g. a photo hung in church, a group photo printed for a class craft project, in a slide show during VBS closing worship) but please do not include my child's photo on your social media, newsletter, or website.
No. Please do not include my child in any photos.
Medical Info
Family doctor name and phone number
Health insurance company
Health insurance policy number
Submit
Description
Register your child for VBS fun at Polk City United Methodist Church!
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