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Shipwrecked VBS Registration 2018
Please fill out a separate form for each child attending Vacation Bible School.
Monday, July 30th-Friday, August 3rd | 6:30pm-9:00pm
Ages 3-12 are welcome!

Living rock Church
33200 Ecorse Rd.
Romulus, MI 48111

Email address *
First Name *
Child's First Name
Your answer
Last Name *
Child's Last Name
Your answer
Child's Gender *
Childs Birthdate *
MM
/
DD
/
YYYY
Medical Notes *
Are there any medical conditions or allergies we should be aware of? What are they? Please Include food allergies.
Your answer
First Name of Parent/Guardian *
Your answer
Last Name of Parent/Guardian *
Your answer
Parent's Email Address *
Your answer
Phone Number *
The best number to reach you at if you are needed
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
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