POM Vacation Bible School Student Registration Form
Please complete this form to register your child for VBS 2018.

June 25th-28th 6:30 p.m.-9:00 p.m.
June 29th 7:00 p.m. - 8:30 p.m.

625 Lotus Drive North Mandeville, LA 70471, USA
Contact us at (985) 727-9886 or or information@thepom.org

Registration is due by Sunday, June 3rd in order to insure the student receives a t-shirt.

Email address *
Contact Information
Name *
Your answer
Nickname
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Ages as of June 1st *
Your answer
Gender
Mother / Guardian Name *
Type (n/a) if not applicable.
Your answer
Mother / Guardian Phone Number *
Type (n/a) if not applicable.
Your answer
Father / Guardian Name *
Type (n/a) if not applicable.
Your answer
Father / Guardian Phone Number *
Type (n/a) if not applicable.
Your answer
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