Michael Carpenter June 19, 2017 VACATION BIBLE SCHOOL 2017 Michael Carpenter June 19, 2017 Dates: June 19 - 23 (Monday-Friday)Time: 8:30 am - 11:30 amAges: PreK - 6th gradeVBS FAMILY NIGHT: June 25 (Sunday)| 6 pm501-889-2015 VBS REGISTRATION FORM 2017 Child's Name * First Name Last Name Gender Male Female Child's Age Date of Birth MM DD YYYY School grade or stage COMPLETED * 4 years old & potty trained Pre-K Kindergarden 1st 2nd 3rd 4th 5th 6th My Child would like to be in a group with If unsure, leave blank Parent 1 Name (Required) * First Name Last Name Parent 1 Relation To Child * Father Mother Legal Guradian Parent 1 Phone Number * (###) ### #### Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent 2 Name (Optional) First Name Last Name Parent 2 Relation to Child Father Mother Legal Guardian Parent 2 Phone Number (Optional) (###) ### #### Caregiver's Mobile Number (If different from parent/guardian) (###) ### #### Email Address Do you have a church home? * Yes No If yes, where do you attend? If no, leave blank Allergies or other medical conditions * If not, type N/A In case of emergency, contact * Phone Number * (###) ### #### Relationship to child * Thank you for your submission! Your child is pre-registered! Please check-in at the foyer in the main church building on Monday June 19th. Doors open at 8 am.
