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
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