Prayer Power VBS Registration
Monday, June 27 - Thursday, June 30
5:30 - 7:00 pm
*Meal provided each night from 5:30 - 6:00 pm for participants and volunteers.

Emanuel UCC
304 East Adams St.
Jackson, MO 63755

Erica @ 270-2259
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Prayer Power VBS Registration (Child)
Student's Name *
Parent/Guardian Name *
I am . . . (select ALL THAT APPLY) *
E-mail Address
Phone *
Student's Age *
Last School Grade Completed *
Home Church (if applicable)
Allergies/Medical Information/Other *
Type "NA" if no concerns.
Emergency Contact 1 *
Type Name and Number
Emergency Contact 2 *
Type Name and Number
Name(s) of person(s) who may pick up this child from VBS: *
Mark "NA" if Adult
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