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
Submit
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