Harlem Baptist Church VBS 2018 Registration

game on FB pic.jpg
 

Date: June 24-27
Time: 5:30 pm-8:00 pm
dinner served each night at 5:30
Ages: 4 years  through completed 5th grade
 

To register your child fill out the information below.

Name *
Name
Parent/Guardian Name: *
Parent/Guardian Name:
Address *
Address
Preferred Telephone Number *
Preferred Telephone Number
Emergency Contact Name (#1) *
Emergency Contact Name (#1)
Emergency Contact Phone (#1) *
Emergency Contact Phone (#1)
Emergency Contact Name (#2)
Emergency Contact Name (#2)
Emergency Contact Phone (#2)
Emergency Contact Phone (#2)