Vacation Bible School

REGISTRATION

Please complete separate registration form for each child

(there is a link back to the registration page when you complete this page and hit "SUBMIT")

DATES: July 22-26

TIME: 9:00-11:30 a.m.

Child Last Name:

Child First Name:

Child Date of Birth (mm/dd/yyyy):

What grade will child begin in Fall/2013? (sorry, no pre-school class available)

Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade

Mailing Address:

City: State:

Zip:

Please list any known allergies or special needs:

If Child is coming with a daycare please include daycare's name & phone #.

Daycare Address & phone#:

Parent/Guardian and Contact Info:

Parent Last Name:

Parent First Name:

Relationship to Child:

Home phone:

Cell phone:

Email Address:

What is the best way to reach you? Phone, Cell, Email

Home Church:

Questions? Call 445-7206.