Vacation Bible School Registration

MAIL IN OPTION:If you prefer to register on paper, please download the 2011 VBS Registration Form, print, complete, sign and mail to Broadus.

PLEASE REGISTER THE FOLLOWING CHILDREN FOR VACATION BIBLE SCHOOL 2011

* First Child's Name

* Age

Second Child's Name

Age

Third Child's Name

Age

Fourth Child's Name

Age

* Are there any allergies or other medical conditions we should know?

* Do you have any special requests (room assignments, friend pairings, etc.)?

* Number of family members participating in Hometown Nazareth:

* Parent/Guardian Name

* Address1

Address2

* City

* State

* Zip

* Email

* Phone

* Cell

* Emergency Contact Name

* Relationship to Child

* Emergency Contact Phone

* Emergency Contact Cell

Check this box to confirm you are the parent or guardian listed above. This will serve as your digital signature for this registration.

I confirm that I am the parent/guardian of the above listed child(ren) *