VBS 2019 Starts Monday June 17th 6 PM
VBS Preregistration for Plaza Community Church 784 Diederich Blvd., Ashland, KY 41101
Email *
Parents Name (First and Last) *
Other than Parents, people that may pick up the children?
Only parents and those listed on this form will be allowed to pick up your child.
Mobile/main contact(Include Area Code) *
Street Address *
City *
State *
Zip Code *
Home Church *
NA if you do not attend or affiliate with a church
Child's Name (First and Last) *
Gender
Clear selection
Child's Birthday *
MM
/
DD
/
YYYY
Child's Age *
Last School Grade Completed *
Do you have more than one child attending? *
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