Grove Vacation Bible School Student Registration

2010 Vacation Bible School

Dates: June 21 - June 25 Time: 6:00pm - 8:30pm

VBS Student Registration

(fields marked * are required)

Contact Information

* Name:
* Address:
* Zip Code
	,
Home Phone:
Cell Phone:
Email Address:

Attendee Information

* Child 1:

	Medical Conditions (allergies, asthma, etc)

Child 2:

	Medical Conditions (allergies, asthma, etc)

Child 3:

	Medical Conditions (allergies, asthma, etc)

Child 4:

	Medical Conditions (allergies, asthma, etc)

Emergency Contact Information

* Contact Name:
* Cell Phone:
Relationship:
Other Phone: (optional)

Home Church Information (optional)

Church Name:
City:
State:

Note: Parent or guardian must remain on site for students ages 5 and under. For more information contact Dr. Pat Coker-Bell at (757) 484-4149 ext. 308 or send email to vbs@grovebaptistchurch.com.

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