Pine Grove United Methodist Church

VBS Registration:
Child's name:	* required
Parent/Guardian name:	* required
Email address:
Mailing address:
Phone where you can be reached during VBS:
Do you currently attend a church?
Child's Information:
Child's Age:
Date of Birth:	* required
Child's Grade in coming school year:	* required
Allergies/Medical Information:
Other information including, who may pickup your child:
Best way to contact you:	Email address Mailing address