Vacation Bible School Registration

MAIL IN OPTION: If you prefer to register on paper, please download the Vacation Bible School Registration Form (PDF), print, complete, sign and mail to Broadus.

PLEASE REGISTER THE FOLLOWING CHILDREN FOR VACATION BIBLE SCHOOL 2008

* First Child's Name

* Age

Second Child's Name

Age

Third Child's Name

Age

Fourth Child's Name

Age

* Are there any allergies or other medical conditions we should know?

* Number of family members participating in Jerusalem Marketplace:

* Parent/Guardian Name

* Address1

Address2

* City

* State

* Zip

* Email

* Phone

* Cell

* Emergency Contact Name

* Relationship to Child

* Emergency Contact Phone

* Emergency Contact Cell

Check this box to confirm you are the parent or guardian listed above. This will serve as your digital signature for this registration.

I confirm that I am the parent/guardian of the above listed child(ren) *