Bethel AME VBS Student Registration
VBS Date: July 15-19 2019
Church Address: 900 John A. Woods Drive Ann Arbor, MI 48105
Contact the church office with questions: 734-663-3800
Student Name *
Your answer
Student Date of Birth
MM
/
DD
/
YYYY
Grade Level for 2019
Your answer
Allergies/Medical Information or Other Concerns *
Your answer
Student Address
Your answer
Parent Information
Parent/Guardian's Name
Your answer
Parent/Guardian's Phone Number
Your answer
Parent/ Guardian's email
Your answer
Who will Pick Up Child from Program?
Your answer
Will you require transportation *
Required
Dietary restrictions *
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