VBS Registration Form for Holy Redeemer
June 26th - 29th
10:00 am - 12:30 pm
$10 per child
For ages 4 to entering into 6th Grade
One child per form please.
Child's Name *
Your answer
Child's Gender *
Childs' age *
Your answer
Date of Birth *
Your answer
Grade Entering in the Fall of 2017 *
Name of parent(s) *
Your answer
Street Address *
Your answer
City, State and Zip *
Your answer
Home Telephone
Your answer
Parent/Guardian's Cell *
Your answer
VBS Music CD *
Optional for additional $5.00
Required
Allergies or other medical conditions
Your answer
In case of emergency, contact *
Your answer
Contact's Phone *
Your answer
Relationship to Child *
Your answer
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