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VBS Registration Form
VACATION BIBLE SCHOOL -- AUGUST 18 - AUGUST 22, 2014 -- 6:00 - 8:30 P.M.
PROGRAM ELIGIBILITY: FOR EVERYONE BORN BY SEPTEMBER 1, 2010 THROUGH CURRENT 8TH GRADERS.
Name - Child 1:
Date of Birth:
Grade Completed June 2014:
Name - Child 2:
Date of Birth:
Grade Completed June 2014:
Name - Child 3:
Date of Birth:
Grade Completed June 2014:
Parent/Care Provider Name:
Street Address:
City:
State:
Zip:
E-mail address:
School child/children attend:
Home phone #:
Phone # & contact during VBS:
Name of home church, if any:
Any allergies, special needs or other medical conditions?
I am a member of Unity Hill UCC
 Yes
 No
I would like to help volunteer with VBS!
 Yes
 No
 I can help during the week
 I can help prior to VBS Week
Registration fee is $15 for the first child, $10 for each additional child per family.
NOTE: The actual cost per child to run this program is approximately $50. If you can help defray the cost, please consider a larger donation.
Confidential scholarships are available. Please contact the CE Chair at magavik70@yahoo.com. REGISTRATION DEADLINE IS AUGUST 10TH. REGISTRATIONS WILL NOT BE ACCEPTED AFTER THIS DATE.
Please make checks payable to: Unity Hill UCC (write VBS on memo line of check). This Registration form can be submitted directly to the church office by clicking on 'submit'. Payment may be brought to the church office or mailed to: Unity Hill United Church of Christ, 364 White Plains Rd., Trumbull, CT 06611.


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