Kiski Valley Community Church VBS Registration

Kiski Valley Community Church VBS Registration

July 22-26, 2019, 6:30-8:30
Parent/Guardian Information
Name:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone Number

Area CodePhone Number
Child's Name

First NameLast Name
Age During VBS
Child Information
Gender
Birth Date

MonthDayYear
List allergy concerns: (If any)
List medical concerns: (If any)
Emergency Phone #:
Emergency Contact Relationship:
Child's Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Pictures will be taken of the children during the VBS program for our website. Forms will be available at the church if you do not want your child's picture included.
http://kiskivalley.cc/