Student Registration Form
Powerhouse Church of Jesus Christ
Vacation Bible School Registration
Full Name
Enter Student's Full Name
Your answer
Age
Your answer
Parent(s) Names
If adult student enter N/A
Your answer
Address
Your answer
City
Your answer
Zip Code
Your answer
Phone
(919) ###-####
Your answer
Email
Your answer
In Case of Emergency Contact
Please enter name and phone number of emergency contact
Your answer
Allergies or Other Medical Conditions
If none, enter N/A
Your answer
Home Church
Your answer
Person Who Will Drop Off
If using Powerhouse transportation enter van
Your answer
Person Who Will Pick Up
If using Powerhouse transportation enter van
Your answer
Number of Days Student Will Attend
Required
Submit
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