Vacation Bible School 2019 Registration

Child's First Name
Child's Last Name
Child's Nick Name
Child's Birthday
Please List All Allergies
Address Line 1
Address Line 2
State or Region
Home Address
Mother's First Name
Mother's Last Name
Mother's Cellphone Number
Father's First Name
Father's Last Name
Preferred Email
Is Anyone Other Than Parent Allowed To Pick Up Child?
If Yes, Please List Name and Cell Phone Number(s) Below: