First Presbyterian Church Vacation Bible School
305 North King Street
July 13-17, 2009 8:30 a.m.-12 noon
Ages 4 years thru 5th Grade
Child’s Name________________________________________________________________
Parent/Guardian Name________________________________________________________
Address____________________________________________________________________
___________________________________________________________________________
E-mail Address______________________________________________________________
Phone Numbers Home________________ Cell________________ Work____________
Age Information
Date of birth___________________________________ Age___________________
Last school grade completed______________________________________________
Home Church_________________________________________________________________
Allergies/Medical Information/Other
Emergency Contacts
Name __________________________________ Phone__________________
Name _________________________________ Phone__________________
Dismissal Information
Name(s) of persons who may pick up this child from VBS
T-shirt size _____________ Child___ Adult___
Return form to 305 North King, Fax 379-5421, E-mail fpcseguin@att.net
