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Friendship Community Church VBS 2021
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When: July 26-30 2021, 5:30pm - 8:00pm
Registration opens at 5:00pm each day
Where: 1090 Weirich Ave, Washington PA 15301
Contact us at
fccvbs2021@icloud.com
or (724) 746-5198
Child's name (first and last)
*
Your answer
Child's gender
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Female
Male
Child's age
*
PLEASE NOTE: participants must be potty trained, and able to be left in the care of our volunteers. All volunteers are required to have a current Pennsylvania Keep Kids Safe Clearance.
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Child's date of birth
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YYYY
Last school grade completed
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Pre-school
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
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Parent's name (first and last)
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Your answer
Street address
*
Your answer
City
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Your answer
State
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Your answer
ZIP code
*
Your answer
email address
*
Your answer
Parent or caregiver's cell phone (555-555-5555)
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Your answer
Home telephone (555-555-5555)
Your answer
Home church
Your answer
Allergies, medical conditions, or special needs
Your answer
Emergency contact name (first and last)
If different from parent information above
Your answer
Emergency contact phone (555-555-5555)
If different from parent information above
Your answer
Emergency contact relationship to child
Parent
Grandparent
Sibling
Aunt/Uncle
Other:
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