Summer break registration form

Vacation Bible study 2024 Kindergarten - Grade 7

Director contact Rae-Lynne Scott 778-549-2362 rls7423@gmail.com

Childs name:

First Name

Last Name

Grade completed:

Birthday:

Age:

Parents name:

First Name

Last Name

Home address:

Email:

Phone number:

Home phone number/ alternate phone number:

Emergency contact person and there relationship to the child:

Food allergies

Yes

If you answered yes to the previous question please list them in the box:

Medical concerns

Yes

If you answered yes to the previous question please list them in the box:

Comments: