St. Paul's UCC Vacation Bible School Registration - 2009

"Build a Better World"

All Faiths Welcome! Ages 4-12 -- Invite a Friend!

Location (directions): 101 Worthington Rd., Exton, PA 19341 [610-363-7285]

Date: July 27th - 31st; 3:00-5:30PM       Cost: Free!

Three (3) Ways To Register! 1) This online form; or 2) & 3) Click here for mail or fax in form.
 

(One form per child, please)
Child's First Name
  		Child's Last Name
 		 Child's Birth Date mmddyyyy
  
Street Address
 		 City
 		 State
 		 Zip
 		 Grade Completed
 
Home Phone 610-555-1234
 		 Cell Phone 610-555-1234
 

Email Address
 
Parent/Guardian
 		 Church Affiliation
 
Emergency Contact
 		 Emergency Phone 484-555-1234
 
Person(s) to Whom Child  May Be Released (one per line)
 
Allergies and/or Limitations Our Staff Should Be Aware of
Please type the word "None" if appropriate
 
How did you hear about our VBS?
St. Paul's member/friend     website    newspaper ad
 from a friend     other		 Click here to return to
St. Paul's UCC main page