Vacation Bible School 2014

June 23-27

6:00 - 8:30pm

For children ages 4 to completed 5th Grade

*Note: Your child must be at least 4 years old by June 30.*

Child's Name *
First Name
Middle
Last Name
Date of Birth*
Grade Completed/Age *
Address *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Contact Number*
Email Address*
Parent's or Guardian's Name*
Home Church
Allergies
Additional Comments/Requests
We sometimes use pictures to promote VBS. Please check to give us permission to use your child's photo*