VBS Registration Form

Camp Middleburg VBS Registration

Fill out the form to register your child for our Camp Middleburg Vacation Bible School. June 5-9, 9-11:30a.m. Your child must be 3 1/2 by June 1 to register.
Child #1

First NameLast Name
Grade this past school year.
If not in school yet put child's age.
T-shirt Size
Food Allergy

YesNo
Child #2

First NameLast Name
Grade this past school year.
If not in school yet put child's age.
T-shirt Size
Food Allergy

YesNo
Child #3

First NameLast Name
Grade this past school year.
If not in school yet put child's age.
T-shirt Size
Food Allergy

YesNo
Child #4

First NameLast Name
Grade this past school year.
If not in school yet put child's age.
T-shirt Size
Food Allergy

YesNo
Parent Name(s)

First NameLast Name
Parent E-mail
example@example.com
Phone Number
Emergancy Contact
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Any Food Allergies or Additional Comments
Optional Payment

prevnext( X )
USDSuggested Fee of $30/child
Should be Empty:

Camp Middleburg VBS Registration