Vacation Bible School

                                 June 6 - 10    8:45 to 12 noon

                                  [Rising PreK4 or age 4 by Sept 1^st

                                     through Rising 6^th graders)

PLEASE INCLUDE A $10 REGISTRATION FEE WITH THIS FORM AND RETURN TO CHURCH OFFICE OR THE REGISTRATION BOX IN THE FELLOWSHIP HALL.

Child's Name:                                                                                        

Parent/Guardian Name:                                                                          

Address:                                                                                              

E-mail Address:                                                                                     

(Cell)                               (Home)                         (Work)                        

Date of Birth: _________Age: ______ Last grade completed: __________

Allergies/Medical Information/Other

Emergency Contacts

Name______________ Cell _________ Work___________

Dismissal Information  Name(s) of person(s) who may pick up this child:

                               FOR OFFICE USE ONLY

   CHEF GROUP________________________

   REGISTRATION FEE PAID:     Yes ¨     No ¨

   ARE PARENTS HELPING WITH VBS? ______ IF YES, WHERE?