Explorer Registration Form

Melissa Schleinkofer – Coordinator
mxcook8@yahoo.com

Explorer Registration Form

Student Name(Required)

First Last

Parent / Family / Guardian Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email Address(Required)

Home Phone

Cell Phone(Required)

Work Phone

Student Date of Birth(Required)

Age(Required)

Last School Grade Completed

Home Church (if any)

Friends of Your Child at this Church

Special Needs / Allergies / Medical Information / Other

Emergency Contacts

Name:(Required)

Phone(Required)

Name:

Phone

Name(s) of person(s) who may pick up this child from VBS(Required)

Photo Release

Faith Harbor UMC Church/VBS has my permission to use my child's photography publicly in VBS materials. I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Consent(Required)

I agree to the above stated photo release

Parent / Guardian's Signature(Required)

Date(Required)

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Printable Explorer Registration Form

Click the form below to open in new window to print

Explorer Registration Form

Melissa Schleinkofer – Coordinator mxcook8@yahoo.com