VBS 2018 Registration

Shipwrecked – VBS 2018

Sunday July 15 to Thursday July 19; 7-9PM | Lessons, Music, Games, and Crafts! For ages 3-12!

Child's Name:

Child's Gender:

Child's Age:

Child's Birthday:

Address:

City:

State:

Zip:

Parent/Guardian:

Home Number:

Cell Number:

Email Address:

Home Church:

Allergies or Medical Conditions:

Emergency Contact Name:

Emergency Contact Phone Number:

I hereby authorize and consent to the use of the above registrants visual image by the Penn Hills Alliance Church, for appropriate purposes, including but not limited to: still photography, video, electronic and print publications and websites. I give this consent with no claim for payment: YesNo

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