Shipwrecked! VBS REGISTRATION
June 25 - 29, 2018
9:30 - 12:30
Valley Vineyard Church
6642 Reseda Blvd. RESEDA, CA 91335
$30 per child
eMAIL Address *
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Parent's First Name *
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Parent's Last Name *
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Mobile Phone Number *
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Home Address - Street *
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City *
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ZIP *
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Medical Insurance Company Name *
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Insurance Policy # *
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Name of children's doctor *
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Telephone Number of Doctor *
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Emergency Contact Name *
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Emergency Contact Phone # *
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