Growing Friends in Christ

VBS Registration Form

Registration Form

VBS 2010

Date

Child's Name Male Female Email Address

Address City State, Zip

Home Phone Cell Phone Birth Date

Age

IN CASE OF EMERGENCY, CONTACT:

Mother (Name, Address, Cell #)

Father (Name, Address, Cell #)

Other (Relationship to child, Name, Address, Cell #)

Allergies or other condition which may limit snacks or activities

I would like to purchase a "Galactic Blast" CD for $5.00 (Due on August 2) Yes No

Grade (just finished)

There is a $15.00 charge per child (3 or more children - $35.00) due at time of registration. Scholarship Funds are available. Call the church office for more information.

Church Use Only

Fee Paid Yes No

Cash__________ Check__________

Date_____________

Room #________________

Monday Tuesday Wednesday Thursday Friday