Printable Registration Form

Vacation Bible School /Escuela Bíblica de Vacaciones
July 25-29, 6:00-8:30 PM
Registration Form
(One Per Child)
Formulario de inscripción para los niños
For children 3 yrs old - finished 5th grade.
Child’s name:___________________________________________ Child’s gender: ____________
Child’s age:________Date of birth:_______________ Last school grade completed:_________
Name of parent(s):__________________________________________________________________
Street address:_____________________________________________________________________
City:________________________________________ State:_________ ZIP:___________________
Home telephone: (_______)__________________________________________________________
Parent/caregiver’s cell phone: (_______)_______________________________________________
Home e-mail address:_______________________________________________________________
Home church: _____________________________________________________________________
Crew number or name (for church use only):__________________________________________
Allergies or other medical conditions:_________________________________________________
In case of emergency, contact:_______________________________________________
Phone: ___________________________________
Relationship to child:________________________________________________________
Please complete one form per child and put it in the offering, or drop at the church.
Providence Assembly of God/Iglesia Comunitaria Cristiana, 353 Elmwood Ave. Providence, RI