Newman Congregational Church
Vacation Bible School (VBS)
August 16 - 20, 2010 from 9am - 12pm
$15 per child, $25 maximum per family
Registration Form

Child's Name

Parent/Guardian Name

Address

Email Address

Phone Numbers
       Home
       
       Cell
       
       Work

Age Information
       Date of Birth

       Age

       Last School Grade Completed
               (as of July 2010)

Home Church

Allergies/Medical Information/Other


Emergency Contacts
       Name
       
       Telephone

       Name

       Telephone

Dismissal Information -
Name(s) of person(s) who may pick up this child from VBS