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2008 Club VBS Registration

Please complete if you are enrolling your child (ages 3 yrs - 6th grade) in our Mini Vacation Bible School to be held July 13-17, 2008. Please fill out a separate form for each child you are enrolling.

Sunday, July 13      Time: 5:30 - 7:30 p.m.

Monday - Thursday, July 14-17      Time: 6:00 - 8:00 p.m.

* Required Fields
*Child's Name:  
Child's Email Address:  
*Parents/Guardian's Name:  
*Parent/Guardian (Your) Email Address:  
*Address:  
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*Home Phone:  
Your Work Phone:  
Your Cell Phone:  
*Birthdate:  
Age of Preschooler (as of July 13, 2008):  
Last grade completed prior to Cactus Canyon (Grades 1 - 6):  
*Medical or other information we need to know. Please include any allergies.:  
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Does child go to Sunday School anywhere? If so, where?:  
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*In the event of an emergency, whom do we call? Please give two contact names and telephone numbers where they may be reached.:  
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*Who may pick up this child at the end of VBS each evening? Please give names of anyone who you think will need to pick up your child.:  
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Please click the Send button only once.