2020 Vacation Bible School Registration

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VBS is June 10th - 12 from 6:00 PM-8:00 pm. It is open to ALL children ages 5 to 11. You can register multiple children from the same family using this form.

Parkway House of Prayer is located at 3230 King Street Roanoke Va, 24012.

Please contact Melanie Thompson with any questions. email: timewithmelanie@gmail.com phone: (540) 982-0115

Child's Last Name *

Child's First Name *

Birthday *

YYYY

Grade Entering in Fall 2020 *

What school does your child attend? *

Allergies

Other health information

Address *

Parent or Guardian's Name(s) *

Phone Number 1 (List if the number is mom, dad, etc.) *

Phone Number 2 (List if the number is mom, dad, etc.) *

Can we text you reminders about VBS? *

YES for phone number 1

YES for phone number 2

NO, please do not text either number

Required

Email *

Do you have a home church? If you attend somewhere other than PHOP, please list the name of your church under Other. *

yes, Parkway House of Prayer

yes, somewhere else (list your church name in other)

Other:

Emergency Contact (Not Parent) *

Emergency Contact Phone *

Do you need to register additional children? *

yes

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