2019 Ben Salem VBS - In the Wild
Amazing Encounters with Jesus!
Email address *
Monday, June 24th-28th; 6:30-9pm at the Social Hall
Child's Name: *
Street Address:
City, State Zip *
Parent Name(s): *
Contact Phone # (where we can contact you during VBS) *
Is the number above a landline or cell phone? *
Last Grade Completed: *
Birthdate: *
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DD
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YYYY
May we photograph your child for use in church publications? *
Medical Information/Allergies: *
Emergency Contact Name/Number: *
Names and Relationships of those who may pick up your child at VBS: *
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