VBS 2022 Registration - Pine Shores Presbyterian Church

Vacation Bible School - Food Truck Party: On a Roll with God 2022

First Child\'s Name

Age

Date of Birth

Grade completed as of May 2022

School

2nd Child\'s Name

Age

Date of Birth

Grade completed as of May 2022

School

3rd Child\'s Name

Age

Date of Birth

Grade completed as of May 2022

School

Parent/Guardian Name

Parent/guardian Email

Home Phone Number

Parent/Guardian Cell Phone

Address

Apt, suite, etc.

Country

City

State

Zip code

Parent/Guardian Work Phone

Mailing Address

Please include street address, City, State, and zip code

Pine Shores Member

Other Church

Others to Contact in Emergency

Second Contact

Name, home, work and cell phone numbers please.

Third Contact

Name, home, work and cell phone numbers please

Medical History

Please list any allergies, illnesses, current medications and diet restrictions and explain. If none, please answer \"none\"

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Fieldset