Keepers of the Kingdom VBS Registration
Where: 4640 West Market St Leavittsburg
When: June 19-23, 2023
9:00 am – 12:30**

**Please note VBS ends at 12:30.  A free lunch is provided from 12:00 – 12:30
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Child's First Name *
Child's Last Name *
Child's Address *
Child's City *
Child's Zip *
Home Phone Number *
Child's Age *
Child's Grade Level *
Child's Birthdate (MM/DD/YYYY) *
Food Allergies or Medical Conditions
Mother's Name (Guardian 1) *
Contact # for Mother (Guardian 1) *
Father's Name (Guardian 2)
Contact # for Father (Guardian 2)
Do you attend First Community Church *
Do you attend our AWANA program *
Did someone invite you? If so, please tell us who!
Email Address *
Confirm Email Address *
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