IMPACT VBS 2017 - FIRST CLASS
On a mission of love
Age 3 - 12

7/5 (WED) - 7/7 (FRI) 9AM - 3PM

140 W. Lime Ave. Monrovia, CA 91016
(626) 415-7078
impactharvest@gmail.com

$10.00 Registration Fee
*Check payable to IMPACT Harvest Church
*Venmo ID: @impact (look for our logo please!)

Please make sure to submit the forms below -

* Impact Harvest Church Activity Waiver & Release
https://drive.google.com/file/d/0B6gQAdqmN7KqSE1IOVN2aEU1UkE/view?usp=sharing

* Medical Release Form
https://drive.google.com/file/d/0B6gQAdqmN7KqUUNjNnJ0ZVFJLWs/view?usp=sharing

First Name
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Last Name
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Birthday
MM
/
DD
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YYYY
Parent Name #1
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Parent Name #2
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Authorized Pick Up Name(s)
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Parent's Cell #1
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Parent's Cell #2
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Email address
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Emergency Contact #1 (Name & Number)
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Emergency Contact #2 (Name & Number)
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Emergency Contact #3 (Name & Number)
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T-Shirt - $10
Lunch Options
Required
Referred By (Name)
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