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PUCC VBS Registration
Once you submit this form, please scroll back to the top of the page for the confirmation message.
Registrations must be submitted by June 9, 2024
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* Indicates required question
Child's Name
*
Your answer
Date of Birth
*
Your answer
Age as of 9/1/2024
Your answer
Grade Level as of 9/1/2024
Your answer
T-shirt Size
Youth Small
Youth Medium
Youth Large
Small
Medium
Large
X Large
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Parents' Names
*
Your answer
Phone Number
Please list the best number to reach you
Your answer
Address
Your answer
City
Your answer
Zip Code
Your answer
Member of PUCC?
Yes
No
Email Address
Your answer
Other Contact Name
Please list someone to contact in case parents cannot be reached.
Your answer
Contact Phone Number
Your answer
Allergies or other conditions we may need to know
Your answer
How did you hear about us?
Member of PUCC
Attended Before
From Website
From Church Sign
Other:
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Donation Requested
Donation includes T-shirt
$25 per child; $50 per family
Submit
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