Vacation Bible School 2017
June 19-23rd 9am-12pm at First Presbyterian Church of Harbor Springs
Medical and other release forms will be emailed and are due by June 19th
Student Name (First and Last)
Your answer
Parent/Guardian Name
Your answer
Parent/Guardian Email Address
Your answer
Address
Your answer
Cell Phone Number of Parent
Your answer
Home Phone Number of Parent
Your answer
Student Date of Birth
MM
/
DD
/
YYYY
Last Grade of School Completed
Your answer
Home Church
Your answer
Allergies/Important Medical Information
Your answer
Emergency Contact #1 Name and Phone Number
Your answer
Emergency Contact #2 Name and Phone Number
Your answer
Name(s) and relation(s) of person(s) able to pick up your child(ren) from VBS
Your answer
Phone Numbers of those able to pick up your child from VBS
Your answer
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