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2022 Ben Salem VBS
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Email
*
Your email
Monday, June 24th-28th; 6:30-9pm at the Social Hall
Child's Name:
*
Your answer
Street Address:
Your answer
City, State Zip
*
Your answer
Parent Name(s):
*
Your answer
Contact Phone # (where we can contact you during VBS)
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Your answer
Is the number above a landline or cell phone?
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Choose
Cell Phone
Landline
Last Grade Completed:
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Choose
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade & Up
Birthdate:
*
MM
/
DD
/
YYYY
May we photograph your child for use in church publications?
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Yes
No
Medical Information/Allergies:
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Your answer
Emergency Contact Name/Number:
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Your answer
Names and Relationships of those who may pick up your child at VBS:
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Your answer
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