Fredericksburg Seventh-day Adventist Church 2022 Vacation Bible School Registration
July 17-21, 2022
6:00-9:00 pm

Ages 4-12 years

One form per family. If you are registering more than 5 children, please fill out an additional form for the extra children. If you are filling out the form for any children who are not your own, please use a separate form for them, one per family.

Questions? Contact Jane Treichler: jstreichler@aol.com
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Parent/Guardian Name *
Home Phone/Main Phone *
Cell Phone
Special Instructions
Mailing address for children listed below *
#1 Child's First and Last Name *
#1 Child's Age *
#1 Child's Food Restrictions or Special Needs *
#2 Child's First and Last Name
#2 Child's Age
#2 Child's Food Restrictions or Special Needs
#3 Child's First and Last Name
#3 Child's Age
#3 Child's Food Restrictions or Special Needs
#4 Child's First and Last Name
#4 Child's Age
#4 Child's Food Restrictions or Special Needs
#5 Child's First and Last Name
#5 Child's Age
#5 Child's Food Restrictions or Special Needs
I, the undersigned, do not hold liable the Fredericksburg SDA Church, their staff or volunteers for any accident involving the children listed above. *
I grant permission for pictures to be taken at this event (for slideshow, etc.) to include my children. *
In case of an emergency, the children listed above may be treated by a medical professional. *
Electronic Signature: By typing my name here I am signing this form *
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