Vacation Bible School - Hartford City Wesleyan Church (July 24-28 - 6-8:30pm)

Please fill out one (1) form per child and click submit.

Child's Name

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Gender

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Please select all that apply.

Male Female

Birthdate

*

Grade Entering

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Please select all that apply.

Pre-K (4 yrs & above) Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Address

*

Parents/Guardian Name

*

Home Phone

Work Phone

Cell Phone

*

Email

*

This address will receive a confirmation email

Emergency Contact

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Phone

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Relationship to Child

*

Food Allergies

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Please select all that apply.

Yes No

List of Allergies (if no allergies, type NONE)

*

Medical Concerns

*

Please select all that apply.

Yes No

Explain (if no concerns, type NONE)

*

Description

Please fill out one (1) form per child and click submit.

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