Centennial Evangelical Lutheran Church - 2011 Centennial VBS Registration Form

2011 Centennial VBS Registration Form

VBS runs from Monday July 19th to Friday July 23rd from 9 A.M. to NOON. The Closing Celebration will be held Friday Night, July 23rd. VBS is for children 4 years old through 5th grade.
All the following criteria is required to be filled out
Child's Name
Last School Grade Completed
Child's Age
Date of Birth
List allergies/medical needs VBS should be aware of:
Parent or Guardian Name
Relationship to Child if Guardian
Street Address1
Street Address2
City, State
Zip Code
Home Phone
Cell Phone
Email Address
Home Church (if any)
Emergency Contact Name
Emergency Contact Telephone
Emergency Contact Cell
Emergency Contact Email
Emergency Contact Relationship to child
OK TO PICK UP YOUR CHILD (OTHER THAN PARENT/GUARDIAN)
Person #1 Name
Person #1 Telephone Number
Person #1 Cell Number
Person #2 Name
Person #2 Telephone Number
Person #2 Cell Number
Person #3 Name
Person #3 Telephone Number
Person #3 Cell Number
Special Needs/Circumstances:
Parent Signature (Please type your name)

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PHONE: 610·933·1528
FAX:484·204·9513

E-MAIL US:
info@centenniallutheran.org

Centennial Evangelical Lutheran Church
1330 Hares Hill Road
Kimberton, PA 19442

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