Vacation Bible School Registration

June 12-16, 2017

9 a.m. – 12 p.m.

 

Child's Name 1:
Grade child just completed:
VBS Class you want your child in:
Child's Name 3:
Grade child just completed :
VBS Class you want your child in
Please list any allergies or medical concerns:
Child's Name 2:
Grade child just completed:
VBS Class you want your child in
Child's Name 4:
Grade child just completed :
VBS Class you want your child in
Parent/Guardian Name:
Any Individual(s) child(ren) should not be released to:
Emergency Phone:
-
Address:
Church membership:
I'd like to volunteer during the week of VBS:
I give permission for my child(ren)'s picture to be used on Jerusalem's slide show on their website.:
Typing your name here serves as a digital signature.