Newman Congregational Church
Vacation Bible School (VBS)
August 1-4, 2011 from 9am - 12pm
August 5, 2011 from 6:00 pm - 7:30 pm

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 2011)

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