Van Kirk VBS Registration - 2018
Event Timing: June 18-22, 2018
9:00am to 11:30am daily
Event Address: 106 Van Kirk Rd., Monaca, PA 15061
Contact Gina at (724) 775-6884
Child's Name *
Your answer
Age *
Your answer
Grade Completed *
Your answer
Birthday *
Your answer
Parent/Guardian Name *
Your answer
Email *
Your answer
Phone number *
Your answer
Address *
Your answer
Emergency Contact Name/Contact info *
Your answer
Dietary restrictions *
Medical Concerns
Your answer
Is there anything else we should know about your child?
Your answer
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