VACATION BIBLE SCHOOL ON-LINE REGISTRATION FORM

(one per child)

 

WALKER MEMORIAL ACADEMY

Ages 4 years to 6th Grade

July 14-18, 2008

9:00 am - 12:00 Noon

 

To register your child for VBS, please complete the following on-line registration form and click on the "SUBMIT" button at the bottom.  You will receive an acknowledgment that your registration has been received.  Thanks.

 

Name:  Age: 
Date of Birth:  Last Grade in School Completed: 
Street Address:  City:    State:    Zip 
Home Telephone:  Cell Phone: 
In case of Emergency Contact:    at Telephone Number: 
Secondary Emergency Contact:  at Telephone Number: 
Allergies/Medical Conditions: 
Home Church: 
Name of Friends your child might like to be with: 

Please mark with a check if you agree to the following:

  Because I live close to Walker Memorial Academy, I am allowing my child to walk home unattended.
 

  I give permission for my child's picture while participating in VBS to be used for a VBS video presentation and publicity.

 

Name of Parent/Guardian: 

Date: 

If you get an internal error message - please disregard - your information still went through.  Thanks!