Kingdom Rock (VBS) Registration
Lord of the Harvest Church
July 26-28 at 6:30pm-8:30pm
7333 McArdle Rd. Corpus Christi, TX. 78412
Child's Name
Your answer
Grade Completed
Your answer
Birthday
MM
/
DD
/
YYYY
Parents/Guardian name
Your answer
Parents/Guardian Number
Your answer
Emergency Name
In an emergency we may use this number to contact parents/guardians.
Your answer
Emergency Number
In an emergency we may use this number to contact parents/guardians.
Your answer
Parent's Email
Your answer
Home Adress
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Siblings Names Atteding Kingdom Kids
Your answer
People who may pick up the child from VBS (Must be an adult over 18 years old)
Your answer
Allergies/Medical Concerns
By submitting this form and clicking "Next" you agree to "MINOR RELEASE Document". (We will have a paper copy of the "Minor Release Document" at check-in to fill out.)
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