Vacation Bible School Registration 2014

2014 Vacation Bible School Registration

* Indicates required field

Child's Name *

First

Last

What grade is your child going into this fall? *

T-shirt size *

Parents Name *

First

Last

Phone Number *

Cell Phone *

Email *

Emergency Contact & Phone number *

Relationship to you? *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Facts concerning the child’s medical history, including allergies, medications being taken and any physical impairments to which a physician should be alerted. *

yes no

Church Bus Authorization

If Yes- List Allergies, Medications being take. *

Do You need Transportation *

Yes No

Location for bus pick up *

Location for bus drop off *

Submit