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Vacation Bible School Registration
Event Timing: July 8-12, 2019
Event Address: 293 Place St., Lucknow
Contact us at (519) 528-3133 or
lucknowvbs@gmail.com
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* Indicates required question
Email
*
Your email
Child's Name (First & Last)
*
Your answer
Child's Gender
*
Female
Male
Child's Age (as of December 31, 2018)
*
4
5
6
7
8
9
10
Child's Birthdate
*
MM
/
DD
/
YYYY
Medical Information (allergies, asthma, etc.)
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N/A
Other:
Parent/Guardian Name
*
Your answer
Address
*
Your answer
Home Phone #
*
Your answer
Cell Phone #
*
Your answer
Home Church
Your answer
In Case of Emergency Contact (name & phone #)
*
Your answer
Would you like to purchase a CD with this year's music for $5
*
If registering multiple children, you only need to check "Yes" once. If you want more than one CD per family, please note it in the comments section. Thanks!
Yes
No
Yes, but unable to afford the cost
Questions or Comments
Your answer
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