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
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