Vacation Bible School Form

Vacation Bible School Registration Form

Having trouble submitting this form? Please send an email describing the error to technology@rpcsda.org.
Theme: GO FISHING

Location: CCF 10411 Greenbelt Road in Lanham

Dates: Friday, July 8 to Sunday, July 10, 2011

Time: 6pm - 8pm
I am registering my child(ren) for the following dates (check all that apply)
CHILD INFORMATION

Please enter information for each child.

List All Allergies, Special Needs or Conditions For Each Child
FAMILY INFORMATION
Child Lives With (check all that apply)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
.

Primary Contact
Contact Information for:
Name

First NameLast Name
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-mail Address
.

Secondary Contact
Contact Information for:
Name

First NameLast Name
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-mail Address
In case of an emergency where I cannot be reached, I hereby authorize RPC medical staff to administer needed first aid or seek medical attention for my child(ren).
Please e-sign by typing in your first and last name below

First NameLast Name
*RPC will take a photograph of your child for identification and use on the web page, etc.*

Mailng Address: Restoration Praise Center - PO Box 342 - Greenbelt, MD 20768

Web www.rpcsda.org/kids - Email childrensministry@rpcsda.org
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