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
City
State / Province
Postal / Zip Code
Parent Cell/Home Phone Number
*
-
Area Code
Phone Number
Additional Parent Phone Number
-
Area Code
Phone Number
Parent Email
*
example@example.com
Emergency Contact/Relationship with Child
*
If Parent/Guardian is not available.
Emergency Contact Phone Number:
*
-
Area Code
Phone Number
Child # 1
*
First Name
Last Name
Gender
*
Male
Female
Age/Grade (Completed)
*
PreK 4 Years
PreK 5 Years
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergies/Special Needs/Other Things We Should Be Aware Of
(Optional) VBS Shirt $5 each
Youth XS
YS
YM
YL
YXL
Adult S
Adult M
Adult L
Child # 2
First Name
Last Name
Gender
Male
Female
Age/Grade (Completed)
PreK 4 Years
PreK 5 Years
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergies/Special Needs/Other Things We Should Be Aware Of
(Optional) VBS Shirt $5 each
Youth XS
YS
YM
YL
YXL
Adult S
Adult M
Adult L
Child # 3
First Name
Last Name
Gender
Male
Female
Age/Grade (Completed)
PreK 4 Years
PreK 5 Years
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergies/Special Needs/Other Things We Should Be Aware Of
(Optional) VBS Shirt $5 each
Youth XS
YS
YM
YL
YXL
Adult S
Adult M
Adult L
Child # 4
First Name
Last Name
Gender
Male
Female
Age/Grade (Completed)
PreK 4 Years
PreK 5 Years
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergies/Special Needs/Other Things We Should Be Aware Of
(Optional) VBS Shirt $5 each
Youth XS
YS
YM
YL
YXL
Adult S
Adult M
Adult L
I authorize that my child's image may be photographed, filmed and used in video, print, and web presentation at Rising Hope Church.
*
Yes
No
Submit
Should be Empty: