PHPC VBS 2019 Summer Seaquest Registration
Palmetto Hills Presbyterian Church
June 17 - June 21
9am - 12pm
K4 - 5th grade (completed)
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) *
Allergies
Your answer
Shirt size *
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 *
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