High Seas Expedition VBS Registration 2017

Parent/Guardian Name

Your Email

Home Phone

Street Address

City
---PA

Child(ren)'s Name(s), Grade, and Age
---Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade---4567891011
---Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade---4567891011
---Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade---4567891011
---Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade---4567891011

Allergies

Home Church

Emergency Contact

Signature

My child/ren has/have permission to attend and participate in High Seas Expedition VBS Program at Cornerstone Fellowship