COMMUNITY VACATION BIBLE SCHOOL 2018

June 11-15
6:00 - 8:30 p.m.
@ Knox United Methodist Church
NAME OF CHILD:
 *
DATE OF BIRTH:
 *
AGE:
 *
LAST GRADE COMPLETED:
 *
PARENT/GUARDIAN:
 *
ADDRESS:
 *
CITY:
 *
STATE:
 *
ZIP:
 *
HOME PHONE:
 *
CELL PHONE:
 *
EMAIL ADDRESS:
 *
EMERGENCY CONTACT NAME:
 *
EMERGENCY CONTACT NUMBER:
 *
CHILD'S SPECIAL NEEDS? ALLERGIES? LIGHT SENSITIVITY? ETC. (If none, write "none".)
 *
HOME CHURCH (If none, write "none"):
 *
SIBLINGS ALSO ATTENDING VBS -Include names and ages. (If none, write "none".)
 *
PEOPLE WHO MAY PICK UP YOUR CHILD (If none, write "none".)
 *
"I permit photos of my child to be used in promotional materials including the websites of Edenberg Presbyterian and/or Knox United Methodist."
 *
Verification Code:
Insert above code:
 * Required


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