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VBS Registration Form for Holy Redeemer 2018
June 25th - June 28th
10:00 am - 12:30 pm
$10 per child
For ages 4 to entering into 6th Grade
One child per form please.
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* Indicates required question
Child's Name
*
Your answer
Child's Gender
*
Male
Female
Childs' age
*
Your answer
Date of Birth
*
Your answer
Grade Entering in the Fall of 2018
*
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Name of parent(s)
*
Your answer
Street Address
*
Your answer
City, State and Zip
*
Your answer
Home Telephone
Your answer
Parent/Guardian's Cell
*
Your answer
VBS Music CD
*
Optional for additional $7.00
Yes - I agree to pay $7.00
No, Thank You
Required
Allergies or other medical conditions
Your answer
In case of emergency, contact
*
Your answer
Contact's Phone
*
Your answer
Relationship to Child
*
Your answer
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