New Hope Christian Church of Wayne

Vacation Bible School Online Registration

Please submit one form per child.

Child's Name:
Grade Completed:
Parents' Names:
Email Address:
Emergency Contact Name:
Emergency Contact Phone:
Food Allergies: Yes No     If yes, please list:
Medical Concerns: Yes No     If yes, please explain:
People Who May Pick Up the Child:
By submitting this form, I confirm that the information on this form is accurate.