2017 Bethany VBS
Event Timing: June 23rd - 25th, 2017
Event Address: 293 W Passaic Ave., Bloomfield NJ 07003
Contact us at (201) 681-7343 or ibethanyorg@gmail.com
Child's Name:
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Child's Gender:
Child's Age:
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Date of birth:
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DD
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YYYY
Last school grade completed:
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Name of parent(s):
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Address (Street, City, ZIP):
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Parent/caregiver's cellphone:
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Home church (If not Bethany):
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Allergies or other medical conditions:
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In case of emergency, contact (name/phone #/relationship to child):
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I understand that I will have to pay $30 per child or $70 for 3 or more children upon arrival
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