Join Us... CROCODILE DOCK VBS at Word Fellowship Church
Word Fellowship Church
For all children entering 1st grade - age 12 welcome!
10 West Laurel Road
July 6th - July 10th
Stratford, NJ 08084
Phone: 856-435-1771
6:30pm to 9:00 pm
Participant Information
*
First Name
*
Last Name
Sex
Male
Female
*
Birth Date
*
Grade Last Completed
K
1st
2nd
3rd
4th
5th
6th
*
Did you attend our VBS last year?
Yes
No
Referred by
Home Church
Allergies/Medical Needs
Household / Adult Primary Contact
*
First Name
*
Last Name
*
Relationship to Participant:
Mother
Father
Guardian
Other
*
Address
Email Address
*
City
*
State
*
Zip
*
Phone
Cell Phone (Mom)
Cell Phone (Dad)
Emergency Contact Information
*
Emerg. Contact First Name
*
Last Name
Relationship to child:
*
Emerg. Phone Number
GUARDIAN'S CONSENT
I Agree
I Disagree
*
I am the parent or guardian of the above named child on this application. I hereby grant permission for Word Fewwloship Church to photograph, videotape, and/or record my child's voice and sounds and to use any or all such photographs, recordings and reproductions thereof in and/or as a part of any video production, published products, related advertising, dislpays, or in exhibition uses. I affirm that I have the legal right to issue such consent.
*
Indicates Response Required
Powered by
FormSite.com