Vacation Bible School Registration
Mifflin Presbyterian Church
June 4 - 8, 2018 from 9:00 am - 11:30 am

There is no cost for VBS at Mifflin.

Guardian's First Name *
Your answer
Guardian's Last Name *
Your answer
Participant's First Name *
Your answer
Participant's Last Name *
Your answer
Participant's Gender *
Grade Completing *
Youngest participants must be 4-years-old at the time of VBS and have attended an organized preschool.
One friend may be listed who will be in the same group as this child
Your answer
Address
Your answer
Contact Phone 1
Your answer
Contact Phone 2
Your answer
Parent Email
Your answer
Do we have your permission to take pictures of your child for social media? *
Would you like a music CD? *
Medical Information
Allergies
Your answer
Medical Concerns
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
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