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Mt. Pleasant Church VBS Registration
VBS will be held August 14-18 from 5:30- 8:00pm (dinner provided)
There will be a short program on Friday August 19 at 6:00pm!
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* Indicates required question
Parent/ Guardian Name
*
Your answer
Address- City- State- Zip
*
Example: 500 Main St, Ashland, MO 65010
Your answer
Phone Number
Example: (573) 212-3131
Your answer
Email Address
*
Example:
email@gamil.com
Your answer
Emergency Contact 1 (Name & Phone Number)
*
Example: John Smith (573)-123-4567
Your answer
Emergency Contact 2 (Name & Phone Number)
*
Example: John Smith (573)-123-4567
Your answer
Who may pick up your child at the end of each day?
*
Please list anyone who is allowed to leave with your child.
Your answer
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