VBS

Where? United Presbyterian Church
When? June 23-26
What time? 9:00 – 11:30am

Please email upckidmin@gmail.com for information and to register

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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