Vacation Bible School
June 6-10, 9am - 12pm
For children 4 years old (by 2015) through grade 5

Child's Name *
Child's Name
Child's Birthdate *
Child's Birthdate
Parent/Guardian Name
Parent/Guardian Name
Address
Address
Phone *
Phone
Emergency Contact
Emergency Contact
Name of person to contact in case of an emergency if parent/guardian is not available.
Emergency contact phone number
Emergency contact phone number