Join us for our 2012 Vacation Bible School
July 23rd-July 27th at 6:30pm
Please Pre-Register here
Student's name
Address
City
State
Zip
Home Phone
E-mail address:
Date of Birth
Age
Grade student will be entering
Home Church
Home Church City
State
Brothers or sisters names
Other information
Name of a special friend your child might like to be with
Need transportation?
Parent/Guardians name
Home phone#
Mom's cell#
Mom's work#
Dad's cell#
Dad's work#
Allergies/Medical conditions
Emergency Contact
Emergency Contact Phone#
Relationship to child
Persons other than parent authorized to pick up your child
Additional Phone#
