VBS Registration
Register my child for Camper Firelight!
Where: Warsaw Assembly of God Church (703 Elm St.)
When: July 30th, 31st, August 1st, 4:00pm until 6:30pm
For more information call 660-438-6244
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Email *
Child’s name *
Birthdate     *
MM
/
DD
/
YYYY
 Grade completed *
Address *
Parents/Guardians *
Work Phone
Cell Phone *
Emergency contact name & relation to child *
Emergency Contact Phone *
Who can pick up your child? *
Food Allergies
Medical Concerns
Transportation Needed:  Please Sign Transport Permission Slip at end *
You may register additional children on the same form: Please list name, age, grade, allergies & medical concerns
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