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Illumination Station VBS Registration
Dates: July 29-31
Open Arms Community Church
2205 Danville HWY
Lebanon, KY 40033
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Child's Name (First and Last)
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Your answer
Parent/Guardian Name (First and Last)
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Your answer
Child's Current Age
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2-3
4-6
7-9
10-12
Parent Phone Number
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If we cannot reach you, who else could we call in case of an emergency? (Name and phone number)
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Your answer
School Grade (just completed)
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Pre-K
K
1st
2nd
3rd
4th
5th
6th
Who is allowed to pick up your child? (Name(s) and relation to child)
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Allergies/Medical Needs we need to be aware of?
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