Sign up for Vacation Bible School
June 15-19, 2009;
9:00 AM - Noon
Ages 3 years old through the 5th grade
Contact Information
Parent/Guardian Information:
Full Name:
Address
City and State
Zip Code
Home Phone
Emergency Contact Name
Emergency Contact Phone
(e.g. Cell Phone)
Home Church
Email Address:
Child's Information: (All young children must diaper independent)
First Name
Last Name
Child's Name Attending
Date of Birth
Last Grade Attended
Grade?
Not in school yet (no Diapers)
K
1
2
3
4
5
2nd Child's Name
First Name
Last Name
Date of Birth
Last Grade Attended
Grade?
Not in school yet
K
1
2
3
4
5
3rd Child's Name
First Name
Last Name
Date of Birth
Last Grade Attended
Grade?
Not in school yet
K
1
2
3
4
5
Enter any Special Needs (including allergies or medical conditions) in the space provided below: