Event registration
Vacation Bible School
"Shipwrecked - Rescued by Jesus"
June 28-30, 2021
5:30 p.m. - 8:15 p.m.
Child's Full Name: *
Child's gender: *
Child's age: *
Child's date of birth *
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Last school grade completed: *
Name of parent(s): *
Street address: *
City: *
State: *
Zip: *
Home telephone: *
Parent/caregiver's cellphone: *
Home email address:
Home church:
Allergies or other medical conditions: *
In case of emergency contact: *
Phone: *
Relationship to child: *
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