VBS

Where? United Presbyterian Church
When? June 10-13
What time? 9:00 – 11:30

For information, cal or contact Michelle Harris at UPCkidmin@gmail.com

Child's Information

Child's Name *
Child's Gender *
Child's Age *
Date of Birth *
Last school grade completed *
Name of Parent(s) *
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Home Telephone
Parent/caregiver’s cellphone
Home Email Address
Home Church

Other Information

Crew number or name (for church use only)
Allergies or other medical conditions
In case of emergency, contact
Phone
Relationship to child

Verification

Please enter any two digits *Example: 12
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