Childs Name:                                            __________________

Parents Name:                                          __________________

Address:                                                     ___________________

                                                                         ___________________

City:                                                            ___________________

State:                              Zip:           _____          

Phone Number:                                      _________________   

Emergency Phone:                                    ________________

Child’s Birthday:            /         /                 

Grade entering in the fall:                        

Doctors Name:                                         __________________ 

Doctors Phone Number:                           ________________

Allergies:                                                  ____________________ 

                                                                          ____________________

 Please fill out this form and give it to one of the VBS organizers or mail it to the church at the following address:

 Bonney Lake Nazarene
Attn: VBS REGISTRATION
7410 Myers Road E
Bonney Lake, WA 98391

Comments are closed.