Agape VBS Registration 2010

Child's Name (required)

Parent's Name (required)

Your Email (required)

Address

Phone

Date Of Birth

Last Grade Completed

Emergency Contact (required)

Emergency Phone (required)

Allergies, Food or Otherwise

Have you attended local church in the last 4 weeks?
 Yes No
If so, where?    

How did you hear about our VBS?
 radio newspaper word of mouth poster

Were you invited by a guest today?
 Yes No
If so, who?