MAGNIFIED VBS Child Registration
June 23 - 25. 5:30-8pm. FREE Event at West Valley Foursquare Church 5802 Summitview Ave Yakima, WA 98908. This event is open to children 4yrs old up to entering 5th grade. Children attending must be fully potty trained and able to use the bathroom without assistance. Children older than 5th grade can participate as a volunteer. Please email Angie at angie@wvfc.church with any questions.
Name of Child #1
*
First Name
Last Name
Age of Child
*
K-1, 2-3, 4-5
Allergies, Medications, Other Medical Alerts or Concerns (if none type NA)
*
Name of Child #2
First Name
Last Name
Age of Child
Allergies, Medications, Other Medical Alerts or Concerns (if none type NA)
Name of Child #3
First Name
Last Name
Age of Child
Allergies, Medications, Other Medical Alerts or Concerns (if none type NA)
Name of Child #4
First Name
Last Name
Age of Child
Allergies, Medications, Other Medical Alerts or Concerns (if none type NA)
Name of Parent/Guardian
*
First Name
Last Name
Address of Parent/Guardian
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email of Parent/Guardian
*
example@example.com
Parent/Guardian Phone Number
*
-
Area Code
Phone Number
Name of Additional Emergency Contact
*
First Name
Last Name
Relation to Child
Phone Number of Additional Emergency Contact
*
-
Area Code
Phone Number
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