VBS Registration 2017
Event Timing: July 17 - 20, 2017
Event Address: 2477 W Washington St
Springfield, IL 62702

Able to volunteer? Please contact lhearring@stjohns-springfield.org

FOR AGES 4 YEARS OLD TO JUST FINISHED 4TH GRADE

Child's Name
Your answer
Gender
Current Age
Your answer
Date of Birth
MM
/
DD
/
YYYY
Last Grade Completed in School
Your answer
Name of Parents/Guardians
Your answer
Home Address
Your answer
City
Your answer
State
Zip
Your answer
Home Telephone
Your answer
Email contact
Your answer
Home Church
Allergies or other Medical Conditions
Your answer
Emergency Contact Person
Your answer
Relationship to Child
Your answer
Emergency Contact Phone
Your answer
Submit
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