Romeo United Methodist Church
Monday, June 24, 2019

VBS Brown Bag Bash Registration

Two steps to register online!
1)  Click here to complete the contact page including a note in the Comments section stating the number of children attending VBS - Brown Bag Bash.
2)  Please print the form below and turn in the completed form with payment to the Church office.
 

BROWN BAG

BASH 2019

Presented by Romeo

United Methodist Church

280 N. Main St, Romeo, MI 48065

 

Monday, July 15th – Thursday, July 18th, 2019

Noon – 3 p.m.

 

We invite the youth volunteers of VBS 2019 to join us for Brown Bag Bash. This program immediately follows VBS each day and is an opportunity for youth in grades 6-12 to have lunch together and share in a fun activity around our community! Planned activities for this year include a trip to Stony Creek Metropark, Romeo Dairy Queen, C.J. Barrymores, and a restoration project on the historic Starkweather home at Simpson Park.

 

To register, please complete the form below and submit it to the church office in person or by mail. You may also register online at romeoumc.com and then make your payment to the church office. A donation of $35.00 per student to cover the cost of activities would be greatly appreciated and scholarships are available. Please make checks payable to RUMC.

 

For questions, visit romeoumc.com or contact us at 586-752-9123

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -BROWN BAG BASH REGISTRATION FORM

 

I, (parent/guardian) ________________________, give my child(ren) permission to attend Brown Bag Bash and participate in the day’s activities immediately following VBS and will provide my child(ren) with a bag lunch each day.

 

Family Name: ______________________ Phone: ____________________ Email Address: __________________________

Address: _____________________________________ City: _______________________________ Zip: __________________

Home Church: _________________________ Mother: ____________ Father: ____________ Guardian: _____________

In case of emergency contact: Name: ________________________________ Phone: __________________________

 

Child’s First and Last Name       

Birthdate

Grade Fall 2019

Allergies/Other Concerns

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dismissal Information - Names of person(s) who may pick up child(ren) from Brown Bag Bash:

________________________________________________________________________________________________________

 

For parent/guardian use:

I am willing and able to provide transportation on:

Monday, July 15th_____ Tuesday, July 16th _____ Wednesday, July 17th _____ Thursday, July 18th _____

Number of available seats in my vehicle _____

Name: _________________________________________________ Phone: ________________________________________

 

May photographs be taken of your child(ren) and used for Brown Bag Bash presentations or promotions?

Yes _____  No _____

 

 

Permission Slip / Medical Information & Release Form

Travel Permission with RUMC Adult Drivers

 

Name of Youth:   _____________________________________ Age:  ________

 

Address:  ________________________________________________________

 

City:  ____________________________  State:  ______  Zip Code:  _________

 

Father’s Name:   ______________________ Home Phone:  (      ) ___________

(guardian)                                                                 Work Phone:   (      ) ___________

 

Mother’s Name:  ______________________ Home Phone:  (      ) ___________

(guardian)                                                                 Work Phone:   (      ) ___________

 

Name of other responsible person/guardian in case we cannot reach parents:

 

____________________________  Relationship to youth:  _________________

Phone number:  (      ) ____________

 

Medicine(s) youth cannot take:  _______________________________________

 

________________________________________________________________

 

Allergies:   _______________________________________________________

 

Special Health Problems/Concerns:  ___________________________________

 

________________________________________________________________

 

________________________________________________________________

 

Insurance:   __________________________  Contract No.:  ________________

 

Doctor’s name:  __________________________ Phone:  (      ) _____________

 

 

 

Medical Release

 

I hereby give my permission for (name) __________________________ to attend VBS Brown Bag Bash (Stony Creek Metropark, Romeo Dairy Queen, C.J. Barrymores, and the Starkweather home at Simpson Park: locations subject to change) with the Romeo UMC. In the event of parental/guardian unavailability, I also give permission for my son / daughter to be treated by competent medical personnel as a result of a medical emergency or accident while involved or attending.

 

Date of Event:  July 15-18, 2019                     Date of signing:  _____________

Signed:  _____________________    Relationship to Youth:  _____________