VBS Registration – Susquehanna Valley Baptist Church

Register For VBS

Dates - July 29 - August 1

Time - 6.30 pm - 8.30 pm

Ages - 4-12

First Name *

Last Name *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone Number *

Email Address *

Last Name *

First Name *

Age *

Grade *

Allergies or Special Needs: Please list all. If none, then please type N/A *

Person responsible for pick up (if other than parent) & phone number: *

Emergency Contact Name & Number *