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VBS Registration Form
July 26-30, 2010
9:00 - 11:30 a.m.
Ages 5-11
Name:
*
Grade in fall of 2010:
*
Street address:
*
City:
*
State:
*
ZIP:
*
Parent/Guardian:
*
Home telephone:
*
Email address:
In case of emergency, contact:
*
Relationship to child:
*
Phone:
*
Child may be picked up by:
Please place my child with:
Home church:
Allergies:
Yes
No
If yes, please list:
Medical concerns:
Yes
No
If yes, explain:
T-shirt size:
Youth
S
M
L
Adult
S
M
L
(T-shirt availability guaranteed only if you register by July 1st)
Enter text from verification image:
* Indicates requires fields
Faith Reformed Presbyterian Church
8158 Yellow Springs Rd
Frederick, Maryland
301-662-0662