2018 VBS Online Registration
Homestead United Presbyterian Church-908 Ann Street Homestead, PA 15120
Email address *
Child's Name *
Your answer
Gender *
Child's Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Last school grade completed *
Name of parent **Person will also be the one to contact in case of emergency *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Best phone number to contact **We will also use this number in case of an emergency. *
Your answer
Home Church
Your answer
Allergies or other medical concerns: *
Your answer
Crew Number **TO BE COMPLETED BY STAFF**
Your answer
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This form was created inside of Steel Valley School District.