Vacation Bible School Registration - The Great Jungle Journey

Name(s)

Age(s)

Address

Phone

This address will receive a confirmation email

Emergency Contact

Emergency Contact Phone

Allergies/Medical Conditions

Home Church

Name of friend you would like to be in a group with

My child has consent to participate in Vacation Bible School held at Harlem Reformed Church. I release Harlem Reformed Church from any liabilities that could result from unintentional or self-inflicted harm. I also give permission for my child's picture to be taken and be used in church publications.

I Agree

Signed by Parent/Guardian

Date

Description

July 15-19, 9:00am-11:00am

Please fill out one form per family.

Vacation Bible School Registration - The Great Jungle Journey

Description

Please Fix the Following