VBS_Register

White Memorial Presbyterian Church
Vacation Bible School

June 26-June 30, 2011

Please register by filling out this form and clicking the SIGN ME UP button.

First Name
Last Name
Address
City, State Zip

Age School Grade Boy Girl

Mother
Father

Home Phone eMail

Emergency Contact PhoneCell Phone

Allergies

First Time at White Memorial VBS?Yes
Home Church

	White Memorial Presbyterian Church Vacation Bible School June 26-June 30, 2011
	Please register by filling out this form and clicking the SIGN ME UP button. First Name Last Name Address City, State Zip Age School Grade Boy Girl Mother Father Home Phone eMail Emergency Contact PhoneCell Phone Allergies First Time at White Memorial VBS?Yes Home Church