Parent/Guardian Name Address City State Zip Code Contact Telephone Cell Phone Emergency Contact Telephone Step 1 - Enter Parent/Guardian Information

Step 2 - Information for Child(ren) Little Adventurer’s Name Age Grade Birth Date Allergies/Medical Concerns* Other Concerns/Instructions * We will have a parish nurse available all day in a First Aid/Rest Tent   Lunch - Please bring a sack lunch for each Little Adventurer (beverage will be provided)If not able to bring a lunch, we will have options available – please check this box if lunch will be needed >

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Instructions: After entering information for each child, click the "Enroll Child" button. After all are enrolled, click "Finish Step 2" Note that "Grade" field means last grade completed and is a numeric value. Use 0 for kindergarten or below.

In case of emergency, I understand that every effort will be made to contact me. If I cannot be reached, I herby give Stewartville United Methodist Church/Staff permission to act on my behalf in seeking emergency treatment for my child. In the event that such treatment is deemed necessary by the church/staff, I give permission to those administering emergency treatment to do so using those measures deemed necessary. I absolve the Stewartville United Methodist Church/Staff from liability in acting on my behalf in this regard. This covers activities held during the Vacation Bible School. Step 3 - Medical Information Statement/Agrement

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Click the "I AGREE" button if you have read, understand and agree with the above Medical Information Statement.

Step 4 - Backyard Bash Information     Backyard Bash 5:30 pm for the whole family! - Preferences should equal number attending. Choose 1 or acombination of all 3. Number Attending : Entrèe Choice: Hot Dog(s) Brat(s) Hamburger(s)