Registration for VBS 2008

‘The Bible Tells Me So ’

Child's Name		Date of Birth
Grade or age as of 9/1		Gender
Parent's Names
Are Parents Members of PUCC?
E-mail Address		Home Phone
Address
City		ZIP
Work Phone		Cell Phone
List an Emergency Contact in case the parents cannot be reached.
Contact		Phone
Please List Allergies or Other Conditions we may need to know about