VBS Registration
Service Times: Saturday 6:00 p.m. Sunday 10:00a.m.
100 Timothy Drive, Elizabeth, PA 15037 412-751-0511

VBS Registration

Vacation Bible School

June 25th -29th 9am - Noon

5 YRS. - 5th Grade

Registration is $15

Register by June 21st

Mail Payments to: 100 Timothy Drive, Elizabeth, PA  15037

Make Checks payable to: CHCUMC

**No Open-toed Shoes**



Child's Name:*
Age:*
Birthday*
Grade Leaving:
Address:*
Phone:*
-
Parent/Guardian:*
Parent/Guardian Email:*
Parent/Guardian Pickup Privileges:
Medical/ Allergies:
Emergency Contact Name:*
Emergency Contact Num:*
-

Do you have a friend you would like to be placed with?

If so, please provide name and grade.


Friend Name:
Friend Grade:
Word Verification: