VBS 2019
June 30 - July 3. 6 to 8 pm
72 Vassar Rd. Poughkeepsie, NY 12603
Contact us at (845) 462-3182 or secretary@vrbcpok.org
Parent/Guardian Name *
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Email *
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Address *
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Phone Number (Home and Cell) *
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Child's Name *
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Child's Birthday *
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DD
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YYYY
Grade Just Completed in School *
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Medical Information: Medical or other information we need to know. (Please include any food allergies.) *
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Emergency Contacts : Please provide name and phone number of 2 Emergency Contacts *
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Dismissal Information: Who may pick up your child at the end of each VBS day? (Name and Relationship) *
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Church Information : If you are currently attending a church, what church do you attend?
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May we have permission to photograph you child? *
May we have permission to use your child’s photograph for the purpose of promotion? *
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