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PHPC VBS 2019 Summer Seaquest Registration
Palmetto Hills Presbyterian Church
June 17 - June 21
9am - 12pm
K4 - 5th grade (completed)
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* Indicates required question
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Email Address
*
Your answer
Street Address
*
Street Address, City, State, ZIP Code
Your answer
School Grade will have completed by summer 2019 (children must have just completed grades K4-5th)
*
K4
K5
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergies
Your answer
Shirt size
*
youth xsmall (4-5)
youth small (6-8)
youth medium (10-12)
youth large (14-16)
Parent/Guardian full name
*
Your answer
Contact number
*
Your answer
Emergency contact name (different from Parent/Gaurdian)
*
Your answer
Emergency contact number (will only use if Parent/Gaurdian can not be reached)
*
Your answer
Where did you hear about our VBS
*
School Flyer
Community advertising/sign
Friend or Family
You are a current member or visitor of PHPC
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