VBS Registration Form
“The Pirates Who don’t do anything”
When : June 24 to 28
Where :Bethel UCC (2112 Yingling Dr, Spring Grove, PA 17362)
Child's last Name *
Your answer
Child's first Name *
Your answer
Child's Age *
Your answer
Child’s Grade *
Your answer
Sex *
Child’s Address *
Your answer
City/State *
Your answer
Zip *
Your answer
Parent’s/Guardian's Name *
Your answer
Parent’s/Guardian's Name
Your answer
Parent’s/Guardian's Phone *
Your answer
Parent’s/Guardian's Phone
Your answer
Person to be contacted in case of Emergency
*If Emergency Contact is a Parent/Guardian - Phone number not required
Name -- Phone -- Relationship to Child *
Your answer
Name -- Phone -- Relationship to Child
Your answer
Does your child have any Medical Condition(s)/Food Allergies that we should be aware of? *
Your answer
Is your Child allowed to be Photographed? *
Would you like to help with VBS?
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