VB Registration Form

In the Wild
Vacation Bible 2019 Registration Form
June 7 (5-7:30 pm) and June 8 (10 am-3 pm) lunch
4 years old to finishing 5th grade
Broadway Presbyterian Church

* required fields

* Indicates required field

Child's Name *

First

Last

Parent/Guardian Name *

First

Last

Child's Current Age *

Child's Current School *

Last School Grade Completed *

Relationship to Child *

Parent Grandparent Other

If relationship is "other", please clarify: *

CONTACT INFORMATION:

Email *

Phone Numbers:

Main # (or cell) *

Work Number *

Home Number *

Home Church (name or "none") *

Allergies or other medical information: *

Emergency Contacts (other than parent/guardian):

Name *

Phone Number *

Name(s) of person(s) other than parent/guardian who may pick up this child from Vacation Bible (I.D. required): *

Submit