2017 Vacation Bible School Registration
Hero Central
Discover your Strength in God!
July 17-21, 2017 (Mon-Fri) 9:00 am – 12 noon
Includes daily snack and crafts. $30 per participant.
Age 3 years (potty trained) up thru those who will enter 5th grade in fall 2017
7077 S Simms St, Littleton, CO 80127
www.HeritageUMC.church
303-979-8374
Participant Name (separate form needed for each participant)
Parents' Names (for child participant)
Participant Address
Email Address
City
State
Home Phone
Parent Cell Phone
Child Birthdate (mm/dd/yyyy)
Grade in Fall 2017
Zip
Emergency Contact Name
Relationship to participant
Emergency Contact Phone
Alt. or cell phone
Name of Primary Pickup
Primary Pickup Phone
Name of Secondary Pickup
Secondary Pickup Phone
Food or other allergies
Special Needs or Medical
Needs (describe)
Do you regularly attend a church?
Which one?
Did a friend invite you to VBS?
Who?
I assume all risk and hazards and do hereby release and agree to hold harmless Heritage United Methodist Church (HUMC) and its servants, volunteers,
agents, and employees, from all liability for personal injury or property damage for all actions taken in good faith during HUMC activities. In the event I
cannot be reached or cannot communicate in an emergency, I hereby give my permission to the physician, hospital, or medical service selected by the
leaders of HUMC to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child or myself as named above. It is
understood that a conscientious effort will be made to communicate with me or the emergency contact listed before any action is taken. I consent to the
taking of photographs, video and audio recordings of my child and myself while he/she and/or I participates in any activities associated with Heritage
UMC. I agree that Heritage UMC shall own all rights, copyrights and derivative works. I give my irrevocable and perpetual consent to Heritage UMC to
use, distribute, and publish photographs and video and audio recordings of my child and myself for internal and promotional purposes, including posting at
the church, broadcasting, photo or video presentations, and inclusion in printed materials and electronic or online publications, social media, or
presentations. I (the undersigned) have read this release and understand its terms and execute it voluntarily and with full knowledge of its significance.
Adult Signature (print form, then sign)
Payment Info: Registration Fee is $30 per participant.
Includes snack, crafts, and all supplies.
It is very helpful to the church if payment and registration forms are received by July 2, yet we welcome registrations
thru July 17. Some scholarships available - - Contact Church Office (303-979-8374) for information.
I have enclosed a check. Make Checks Payable to Heritage UMC (write “VBS Registration” & participant name on memo line).
I am paying by credit card.
VISA
Card #
Mastercard Name on Card
Expires
Code on back
Mail SIGNED form with payment to Heritage UMC, 7077 S. Simms St, Littleton, CO 80127
Or bring signed form with payment to church office during business hrs.
Office use only
Turned in _____________ Paid ___________