St. James "Junk Yard Redemption" Vacation Bible School Registration Form
August 12th - August 14th 6:00pm-7:00pm Free Meal Sessions 7:30pm-9:00pm nightly Classes for Ages 5 to Adults
Name of Registrant
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Home Address
Street Address
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any allergies? If yes, please list them below:
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Parent / Guardian/Emergency Contact
Name
First Name
Last Name
Relationship to Registrant
Telephone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Next
Do you allow St. James to take photos or videos during the activities for advertising and marketing purposes that will be posted on social media?
Yes
No
Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: