VBS 2017 Registration

VBS Registration 2017

June 26 - 29 (Mon - Thurs)
9:00 a.m. to 11:45 a.m.

THIS YEAR AT FRITZ PARK!

fall Kindergarten to fall 5th graders
(2017-2018 school year)

$10 (includes t-shirt)

Step One...

Complete Form and Hit Submit Below

* Indicates required field

Camper Name *

First

Last

Age/Grade *

t-shirt size *

Guardian(s) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Best Phone Number *

Email *

Your Additional Children (name, age/grade, t-shirt) *

In case of needed emergency medical treatment, I hereby give permission to the physicians selected by the staff of Hutto Discovery UMC (HDUMC) or his designee to provide and to secure treatment for my child. I further authorize Seton Medical Center Williamson and all other medical facilities providing treatment to release pertinent information to HDUMC staff for the purpose of parental/guardian notification. I recognize the natural risks of injury or disability inherent in my child’s participation in HDUMC’s camp/VBS program, and hereby assume the risk of injury that could result from these activities. I release HDUMC, and the Central Texas Conference of the United Methodist Church and the employees and volunteers of all such entities from liability for injury to my child from participation in these and other programs. I give my permission for my child’s photo(s) to be utilized at the discretion of HDUMC which includes their website. However, I understand no names will be used with the photographs.

I agree to the above release statement *

Yes No

Name of person completing this form *

Date of form completion *

Insurance Company *

Group/Policy # *

Insurance ID # *

Secondary Emergency Contact (Name and Number) *

Allergies, Medical Needs, Notes for Staff, Questions *

After clicking "submit," please remember to pay for registration via PayPal on right side of page.

Submit

Step Two...

Pay through PayPal ($10 per child)

Payment Notes:
You may change quantity for additional children after clicking "buy now." (click "update")
If your PayPal account is not set up in your name (ex. business account), please leave a note to let us know camper's names
Our PayPal Account is shared with our Boy Scout Pack 176.
You may prefer to mail payment to: Hutto Discovery UMC, PO Box 426, Hutto, TX 78634
Please contact Allison Amling with any further questions.
Thank You and see your child in June!

Step One...

Complete Form and Hit Submit Below

Step Two...

Pay through PayPal ($10 per child)

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