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Hummels Church
427 Sassafras Rd
Middleburg, Pennsylvania 17842

Phone: 570-837-9956 570-837-9956

E-mail: hummelschurch23@yahoo.com

Office Hours:

(Regular Hours)

Mondays: 4:30 pm - 8:00 pm Thursdays: 4:30 pm - 8:30 pm Fridays: 8:00 am - 11:00 am

VBS Registration Form

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VBS Registration Form Breaker Rock Beach June 23-27, 6:45-8:45 p.m.

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Name: *

Age (As of June 12th): *

E-mail address: *

Telephone *

Parent/Guardian names *

Emergency Contact 1: *

Emergency Contact 2: *

Allergies to foods/bee stings or anything else we need to know while your child is in our care (for more extensive needs, please talk to someone at the registration table) *

Type your Signature *

Captcha (spam protection code) *

I hereby acknowledge that the information I provided is correct and gave my permission for my child to attend VBS. All children are expected to be accompanied in and out of the Church. Children will not be permitted to leave the church without an adult. Hummel's Church volunteers are "Safe Sanctuary Certified" and will do our best to protect your child in every way while in our care. Hummel's Church and the volunteers are not responsible and cannot be held liable in the event of accident, injury or illness. Children may be photographed for a craft and a slide show to be shown during a worship service.

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