Blyth Community VBS 2019 - Registration
Welcome to Blyth Community Vacation Bible School!
Tuesday July 2 - Friday July 5, 9:00-11:45 a.m. at Blyth Christian Reformed Church
354 Queen St., Blyth, ON N0M 1H0 https://binged.it/2oR1oXQ
for children entering SK - Grade 6
Cost: FREE! (sponsored by local churches)
Contact: Christina Salverda 519-441-2907 christinawynja@hotmail.com
Preview this year's theme at https://youtu.be/_A0VITTzHh4
Share this form with a friend (copy/paste into an email):
http://tinyurl.com/blythvbs2019
Child's First Name *
Your answer
Child's Last Name *
Your answer
Date of Birth *
MM
/
DD
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YYYY
Grade Completed (as of July) *
Your answer
Health Card Number (optional)
In case of emergency, the leaders will make every attempt to contact parents/guardians as soon as possible.
Your answer
Parent's First Name *
Your answer
Parent's Last Name *
Your answer
Street Address *
Your answer
City/Town *
Your answer
Postal Code
Your answer
Home Phone *
Your answer
Cell Phone (if available)
Your answer
Email (if available)
Your answer
Emergency Contact - First Name *
Your answer
Emergency Contact - Last Name *
Your answer
Emergency Phone *
Your answer
Special Needs / Allergies (if any)
Your answer
Person Responsible for Pickup after VBS (if not parent/guardian named above)
Your answer
Person Responsible for Pickup after VBS - Phone
Your answer
Person Responsible for Pickup after VBS - Relationship to Child
Your answer
Our family would like a CD of the VBS songs (optional)
Check box if you DON'T wish your child's photo taken (for showing internally within VBS only)
Submit
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