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VBS Registration Form- 2022
Harrisburg First Church of the Brethren
June 19th- June 23rd
5:00 pm- 8:00 pm
219 Hummel St. Harrisburg, Pa 17104
* Indicates required question
Child's Full Name
*
Your answer
Nickname or Preferred Name
Your answer
Age
*
Your answer
Grade Completed
*
Your answer
Sex
*
Female
Male
Other:
Parent/Guardian Name
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Emergency Contacts
*
Your answer
Allergies/Medical Information/Other Concerns
*
Your answer
Will your child need transportation?
*
Yes
No
Who will pick up your child from the program? (Include name and phone number)
*
Your answer
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