Child's Name *
Child's Name
Child's Birthday *
Child's Birthday
Parent / Guardian Name *
Parent / Guardian Name
Parent / Guardian Phone *
Parent / Guardian Phone
Home Address *
Home Address
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone Number *
Emergency Contact Phone Number
I consent that the child listed above has my permission to attend Vacation Bible School at West Austintown First United Methodist Church, 6749 Mahoning Ave., Austintown, Ohio 44515 on June 26-30, 2017 *