Immanuel Orthodox Presbyterian Church
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Immanuel OPC
Vacation Bible School
June 19 - 23, 2017
8:45AM - 12 Noon
1221 Elm Avenue
Haddon Township, NJ 08107
(856) 685-3705
VBS Registration Form
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Indicates required field
Parent or Guardian Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Home Phone Number
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Work Phone Number
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Mobile Phone Number
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Email
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Home Church
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Additional Parent or Guardian Name
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First
Last
Phone Number
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Emergency Contact
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First
Last
Emergency Contact Address
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Line 1
Line 2
City
State
Zip Code
Country
Emergency Contact Phone Number
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Child Name 1
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First
Last
Age
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Birth Date
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School Grade Completed
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Allergies or Special Requirements of Child 1
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Child Name 2
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First
Last
Age
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Birth Date
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School Grade Completed
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Allergies or Special Requirements of Child 2
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Child Name 3
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First
Last
Age
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Birth Date
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School Grade Completed
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Allergies or Special Requirements of Child 3
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Additional Needs and Requirements. (If you wish to add additional children, list Name, Age, Birthdate, Grade Completed, Alergies for each additional child.)
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Submit Registration
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