Covenant EPC VBS Registration
Please complete a new form for each child.
June 3 - 6 | 9am - noon
Ages 4 - completed 4th Grade
Email address *
Child First Name *
Your answer
Child Last Name *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Last school grade completed *
Your answer
Name of Parent(s) *
Your answer
Street Address *
Your answer
City *
Your answer
Zipcode *
Your answer
Cell Phone #
Your answer
Home church
Your answer
Emergency Name and Phone # (Other than parent/guardian) *
Your answer
Does your child have any allergies? *
If yes, please indicate type of allergies.
Your answer
Name of Person Completing this Form *
Your answer
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