Vacation Bible School Registration
Event Timing: July 31 - August 4, 2023 
Event Address: 293 Place St., Lucknow
Contact us at (519) 955-4401 or lucknowvbs@gmail.com
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Email *
Child's Name (First & Last) *
Child's Gender *
Child's Age (as of December 31, 2022) *
Child's Birthdate *
MM
/
DD
/
YYYY
Medical Information (allergies, asthma, etc.) *
Parent/Guardian Name *
Address *
Home Phone # *
Cell Phone # *
Home Church
In Case of Emergency Contact (name & phone #) *
Questions or Comments
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