CLC VBS (A different kind of VBS)
Location: Oakland Driver Christian Church in Portage, MI
When: June 24-28, 2019
Time: 6:30 - 8:30PM
Email address *
Child's Name *
One submission per child please (You can submit this form multiple times)
Your answer
Grade Completed *
Your answer
Age *
Choose the camp *
Second choice (If primary is filled)
Parent/Legal Guardian Information
Parent/Legal Guardian's Name(s) *
Your answer
Home Address *
Street, City, State and ZIP
Your answer
Primary Phone Number *
Your answer
Alternate Phone Number
Your answer
Emergency Contact
Emergency Contact Name *
Your answer
Relationship to Student *
Your answer
Phone Number *
Your answer
Health Information
Any food allergies? *
If yes, please list allergies
Your answer
Any medical concerns? *
If yes, please list medical concerns
Your answer
Misc Info
Person(s) who may pick up child
(If not already listed as parent or emergency contact above)
Your answer
Is there a friend your child would like to be grouped with?
Your answer
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