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Upward Bound VBS Registration Form
June 22-26, 2009
9:00 - 11:30 a.m.
 Ages 3-11

Name:
Sex: Male   Female
Birth date:
Grade entering:
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:
Attending Sports Camp (for grades 4-6): Yes   No
Lunch: Yes   No
T-shirt size: Youth S   M   L
Adult S   M   L
(T-shirt availability guaranteed only if you register by June 1st)



Faith Reformed Presbyterian Church
8158 Yellow Springs Rd
Frederick, Maryland
301-662-0662