VBS Registration 2017
Date: July 31-August 4 from 5:30-7:45.
Location: Cross Roads Community Church, 271 Main Street, Leechburg, PA
Contact us at 724-845-1901 or church@crcpc.org
Name
Your answer
Birthday
MM
/
DD
/
YYYY
Completed Grade Level
Address
Your answer
Parent/Guardian Name
Your answer
Phone Number
Your answer
Emergency Phone Number
Your answer
Email Address
Your answer
Emergency Contact
Your answer
Alternate Contact Phone Number
Your answer
Medical Issues/Concerns
Your answer
Name of Person Picking up Child(ren)
Your answer
Name of Home Church
Your answer
Submit
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This form was created inside of Cross Roads Community Presbyterian Church. Report Abuse - Terms of Service - Additional Terms