First Baptist Church of Glendale ť VBS 2013 Registration

818-242-2113

209 N. Louise Street

Glendale, California 91206

VBS 2013 Registration

KINGDOM ROCK

Where Kids Stand Strong for God!

REGISTRATION FORM ( One Per Child )

**ALL CHILDREN MUST BE AGES 4 & UP BY JULY 1ST TO PARTICIPATE**

Child's Full Name:*

Child's Preferred Name:

Child's Age:*

Child's Gender:*

M
F

Date of Birth:*

Last School Grade Completed:*

Name of Caregiver(s):*

Street Address:*

City:*

State:*

Zip Code:*

Home Phone #:*

Cell Phone #:*

Email Address:*

Home church:*

Emergency Contact Name:*

Emergency Telephone #:*

Relationship to child:*

Allergies or other medical conditions:*

T-Shirt Size:*

Additional Information We Should Know:

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