Hartwood Presbyterian Church - VBS Registration Form

June 27 - July 1 2016 [9:00AM - 11:30AM]
Age 3 through entering 5th Grade
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Child's Name M/F Age Grade Fall 2015
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  Age as of July 13, 2016

Parent/Guardian Name:
Street Address:
City, State, Zip Code:
Email Address:
Confirm Email Address:
Phone:
Cell Phone:
Allergies-Medications:

Emergency Contact Name:
Emergency Contact Phone:
Emergency Contact Relation:
Who may pick up child(ren) from VBS:

 In case of an emergency, I give permission for my child(ren) to receive medical treatment.