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*
Last Grade of Schoool Completed*
Name of Parent(s)*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Phone*
Parent / Caregiver Cell Phone
Email*
Home Church
Emergency Information
Allergies or other medical conditions
In Case of Emergency Contact
First Last
Phone
Relationship to Child
Adult Class
Adult 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.
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Emergency Information