Elim Church - VBS Heavens Helpers Registration

VBS Heavens Helpers Registration - 2019

Child's Name (First and Last)	*
Child's Age	*
Date of Birth (mm/dd/year)	*
Name of parent(s)	*
Street Address	*
City	*
State	*
ZIP	*
Home Telephone
Parent/caregivers cell phone:
In case of emergency, contact	*
Relationship to child	*
Emergency Contacts Phone number	*
Home Church
Do you give permission to have your child’s photo taken and used for Adventure Chapel advertisements, FB, flyers, etc.	*
Allergies or other medical conditions
By submitting this form you are electronically giving your signature and permission to register your child to this years VBS program. Thank you and we look forward to having a blast learning about Jesus with your child!
Electronic Signature: First and Last Name	*
Last Grade Completed	*
Your Email Address	*
Please type in the box to the right »	*