AGAPE Chinese Alliance Church VBS 2017
Registration Information
Fees: $25/child ($5 off for siblings)
Friday dinner and Saturday lunch included

Date and Time: 7/14/2017(Fri) 6:30pm - 9:30pm, 7/15/2017(Sat.) 9:30am-3:30pm, 7/16/2017 10:30am-12:30pm

Registration Deadline: 7/02/2017

Contacts: Carol (573)202-0502 or Sally (858)349-7571 or email vbs@agapecac.org
Make Check payable to: Agape Chinese Alliance Church

Student Name (Last, First)姓名 *
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Student Gender性別 *
Date of Birth(mm/dd/yy)出生日期 *
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Grade in Fall '16 秋季入學年紀 *
Special Medical Attention and Allergic Information醫療指示及過敏信息 *
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Doctor Name and Phone Number醫生信息
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Parents/Guardians Name家長姓名 *
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Parents/Guardians Phone number家長電话号码 *
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Parents/Guardians email address家長電子邮件 *
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Home Address住宅地址 *
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Other Emergency Contact Name紧急聯络人 *
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Other Emergency Contact Phone number紧急聯络人電话 *
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Church Affiliation有没有参加教會
Names of Siblings Attending This VBS 有兄弟姊妹參加暑期聖經班 (請列出姓名):
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