VBS 2008 Registration Form

Please fill in this form to register. The red dots indicate required fields.

Child's Name   *  
Parent's first name   *  
Parent's last name   *  
Street   *  
City   *  
State   *  
ZIP Code   *  
Home phone   *  
Cell phone    
Email   *  
child's date of birth   *  
Grade entering fall 2008   *  
FPC member   *   Yes
No
If visitor - church attending    
Visitor - My child is a guest of?    
Visitors - Emergency name and phone:    
Visitors, please provide this information.
My child at 11:30 will be:   *  
Unless you select "Picked Up" your child will be dismissed from their room at 11:30.
     


Press the button to confirm your registration.

  

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