VBS Online Form

PCCC Vacation Bible School is July 20 – 22. Sign-up form is below. Daily schedules are as follows:

July 20th - Thursday 6:30pm - 8:30pm
July 21st - Friday 6:30pm - 8:30pm
July 22nd - Saturday 9:00am - 1:00pm
VBS 2017- Ages 4 Years to 6th Grade

VBS 2017- Ages 4 Years to 6th Grade

Name of Child #1
Last grade completed
Birthdate of Child #1
Name of Child #2
Last grade completed
Birthdate of Child #2
Name(s) of Parent(s)
Address of Home
Telephone number at home
Alternative phone number
Name of person to contact in case of EMERGENCY
Phone number of EMERGENCY contact
Relationship of EMERGENCY contact to child
Describe any food allergies
Names and ages of siblings attending VBS
Name of church you may attend
Names and numbers of person's who may pick up child
If you digitally signed the box above, please provide your phone number
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