VBS 2017 Registration Form
Thanks for choosing to register for VBS 2017! We look forward to having a great week learning about the Apostle Paul and the early church.
Details...
Rome VBS will be held in La Harpe from July 31st-August 4th, 2017 from 9am-noon each day. It is a joint effort between the Union Church of La Harpe and the La Harpe Christian Church. Each day will begin and end at the La Harpe Christian Church. VBS is open to children in Pre-K through 8th Grade.
Child Information
Child First Name *
First name of child attending VBS
Your answer
Child Last Name *
Last name of child attending VBS
Your answer
Child Address *
The home address of the child attending VBS
Your answer
City *
City in which child resides
Your answer
State *
State in which child resides
Your answer
ZIP Code *
ZIP Code in which child resides
Your answer
Home Church
The church the child regularly attends (if none, write none)
Your answer
Date of Birth *
Child's birthdate in form of dd/mm/yyyy
Your answer
Grade Entering in Fall *
Select the grade the child will be in this fall (if not beginning school yet, mark Pre-K)
Parent/Guardian Information
Parent/Guardian First Name *
First name of the parent or guardian of the child
Your answer
Parent/Guardian Last Name *
Last name of the parent or guardian of the child
Your answer
Parent/Guardian E-mail
E-mail address at which you can be reached
Your answer
Parent/Guardian Phone Number
The phone number at which you can be reached
Your answer
Emergency/Health Information
Emergency Contact *
Person we can contact in the event of an emergency during the week of VBS (during the hours of 9am-noon)
Your answer
Emergency Contact's Relation *
The relationship of the emergency contact to the child (parent, grandparent, friend, etc.)
Your answer
Emergency Contact Phone # *
Number at which we can reach the emergency contact during VBS
Your answer
Allergies/Special Needs
Please list any allergies or special needs for which we may need to account
Your answer
Other Information
Any other information you think might be helpful for us to have
Your answer
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