EmailMe Form - Prince of Peace VBS Registration

Prince of Peace VBS Registration

Your Name (First and Last Name) *

Your Email Address *

Child's Name (First and Last name) *

Child's Age *

Child's DOB

Child's Gender

School Grade for the 2012-2013 Year (We are sorry but our Pre-school is full.)

Is child potty trained?

Allergies or other medical conditions

If child has special needs, name of adult who will accompany child

Name of special friend you child might like to be with (in the same age category)

Child's Street Address *

City *

State *

Zip Code *

Home Telephone *

Mother's/Legal Guardian's Name (First and Last Name) *

Daytime Phone Number *

Mother's Cell Phone Number

Father's Name (First and Last Name)

Daytime Phone Number

Father's Cell Phone Number

Emergency Contact (Must be other than legal guardian) *

Relationship to Emergency Contact *

Emergency Contact Daytime Phone Number *

Emergency Contact Cell Phone Number

Child's Home Church

Do we have permission to include your child in photographs during VBS week?

Donation (to help cover the cost of VBS) - Check can be sent to the Church

Notes or additional information you would like us to know

VBS Novelty Items

Please send your check for these items to the Church and notate on the check they are for VBS novelty items ordered online. Checks may be sent to 3625 SW Wanamaker Road, Topeka, KS 66614.

I would like to purchase a
Sky T-Shirt for $6.00.

I would like to purchase a
pack of Sky Bible Buddies for $4.00.

I would like to purchase a
Sky music CD for $6.00.

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