VBS 2025

Name of participant

Age of participant

Please list all allergies your child has (including food, medication, or environmental). If your child has no known allergies, please write -None.

Please list any medical conditions or health concerns we should be aware of along with any instructions for care. If your child has no known medical conditions, please write -None.

Emergency Contact Name/ Phone Number/ Relationship to Participant

I hereby grant permission for my child’s image, including photos and videos, to be used for promotional, educational, or media purposes by First United Methodist Church, Park Ridge. I understand that these photos or videos can be viewed by anyone in the world. No identifying information will be displayed.

YES NO

This address will receive a confirmation email

Phone

Address

Payment $20.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

August 13-15, 2025

Please fill out this form and click submit.

VBS 2025

Description

Please Fix the Following