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