Join us for an Island Adventure Every Wed.Night from 6-21-17 to 7-26-17

VBS REGISTRATION FORM

CHILDS NAME:*
CHILD'S AGE:*
DATE OF BIRTH:
T-SHIRT SIZE:*
GRADE ATTENDING NEXT YEAR:*
PARENT/GUARDIAN NAME:*
ADDRESS:*
PARENT/GUARDIAN HOME PHONE:*
PARENT/GUARDIAN CELL PHONE:*
E-MAIL:*
EMERGENCY CONTACT NAME:*
EMERGENCY CONTACT PHONE:*