Shipwrecked 2018 Registration

June 18 - 21, 6 - 8pm | Please fill out one form per child and click submit. We look forward to seeing you at VBS

Child's Name

Child's Gender

Please select one option.

Girl Boy

Child's Age

Child's Date of Birth

Child's last completed grade

Please select one option.

pre-school/young fives kindergarten 1st 2nd 3rd 4th N/A

Child's Allergies or other medical conditions

Name of friend your child might like to be with

Parent or Guardian Name

Parent or Guardian Address

Parent or Guardian Email

This address will receive a confirmation email

Parent or Guardian Phone

What is the best way to reach you?

Please select one option.

phone call text email

Home Church

I approve the use of group photos of my child used to promote Shipwrecked for Midland Free Methodist Children's ministries in it's affiliated print, web, etc.

Please select all that apply.

yes no I'd like more info please

I would like information on volunteer opportunities at Shipwrecked

Please select one option.

yes please contact me about volunteering at pre-school Shipwrecked yes please contact me about volunteering at elementary Shipwrecked No thank you, I am not able to volunteer at this time.

Any Additional Information

There is no charge for Shipwrecked, if you would like to make a contribution it will be used to help provide the best experience we can for every child that attends. If you give any amount, your generosity will be poured right into our kids, thank you.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

June 18 - 21, 6 - 8pm

Please fill out one form per child and click submit. We look forward to seeing you at VBS

Shipwrecked 2018 Registration

Description

Please Fix the Following