2015 Vacation Bible School August 24-28, 6-8 pm (for children age 3 to grade 5) Child's Name* First Last Child's Age (in years)* Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Last Grade of Schoool Completed*Select a Grade1st Grade2nd Grade3rd Grade4th Grade5th GradeName of Parent(s)* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone*Parent / Caregiver Cell PhoneEmail* Home Church Emergency InformationAllergies or other medical conditionsIn Case of Emergency Contact First Last PhoneRelationship to Child Adult ClassAdult Class available for parents and caregivers during VBS. Please indicate here if you are interested in this class:Sign Up Yes, I am interested in the Adult Class held simultaneously with VBS. Captcha