Registration Form

1^st Child’s name ____________________________________________________________

2^nd Child’s Name ___________________________________________________________

3^rd Child’s Name ___________________________________________________________

Parent/Guardian Name ______________________________________________________

Address ___________________________________________________________________

Email address ______________________________________________________________

Phone Numbers: Home _______________ Cell ____________________

T- Shirt Sizes (1^st )_____________ (2^nd) ___________________ (3^rd)___________________ Cost $5.00/each at registration.

Age Information

DOB /AGE___________ DOB /AGE___________ DOB /AGE___________

Last school grade completed ________________ ____________________ _____________________

Home Church ________________________ Are you looking for a new church? ___________

Allergies/ Medical Information

1^st Child ___________________________________________________________________

2^nd Child __________________________________________________________________

3^rd Child __________________________________________________________________

Emergency Contacts

Name______________________________ Phone ________________

Name______________________________ Phone ________________

Dismissal Information

Name(s) of person you may be picking up this child from VBS/Phone #

__________________________________________________________________________

Office Information: Surfer Group assigned/ teacher _____________________________

Return Form to: LakeShore United Methodist Church 33119 Electric Blvd in Avon Lake, Ohio 44012 or contact Karen (440) 933-5238 or email Linda Below @ lbelow@oh.rr.com