Vacation Bible School July 19-23, 2021 ~ 6:00-8:30PM

Vacation Bible School July 19-23, 2021 ~ 6:00-8:30PM

Rising Hope Church Crossroads Campus @ 593 Walnut Bottom Rd. Shippensburg
Names of Parents/Guardians:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Cell/Home Phone Number*

Area CodePhone Number
Additional Parent Phone Number

Area CodePhone Number
Parent Email*
example@example.com
Emergency Contact/Relationship with Child*
If Parent/Guardian is not available.
Emergency Contact Phone Number:*

Area CodePhone Number
Child # 1*

First NameLast Name
Gender*

MaleFemale
Age/Grade (Completed)*
Allergies/Special Needs/Other Things We Should Be Aware Of
(Optional) VBS Shirt $5 each
Child # 2

First NameLast Name
Gender

MaleFemale
Age/Grade (Completed)
Allergies/Special Needs/Other Things We Should Be Aware Of
(Optional) VBS Shirt $5 each
Child # 3

First NameLast Name
Gender

MaleFemale
Age/Grade (Completed)
Allergies/Special Needs/Other Things We Should Be Aware Of
(Optional) VBS Shirt $5 each
Child # 4

First NameLast Name
Gender

MaleFemale
Age/Grade (Completed)
Allergies/Special Needs/Other Things We Should Be Aware Of
(Optional) VBS Shirt $5 each
I authorize that my child's image may be photographed, filmed and used in video, print, and web presentation at Rising Hope Church.*

YesNo
Should be Empty: