VBS Registration 2019
Service Times: Saturday 6:00 p.m. Sunday 10:00a.m.
100 Timothy Drive, Elizabeth, PA 15037 412-751-0511

VBS Registration 2019

Vacation Bible School

June 17th -21st 9am - Noon

5 YRS. - 5th Grade

Registration is $10

Register by June 13th

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

Make Checks payable to: CHCUMC

(if child's last name differs from check please put child's name in memo field)

**No Open-toed Shoes**

Any questions please contact Debbie Walter @ 412.751.0511 ext. 13


Child's Name:*
Age:*
Birthday*
Grade Leaving:
Address:*
Phone:*
-
Parent/Guardian:*
Parent/Guardian Email:*
Names of parent/guardian pick up:
Medical Alerts:
Food 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: