REGISTER TODAY for Brookfield First Assembly of God's 2012 VBS
Dates: August 13-17
Time: 1:00-4:00pm
Where: Brookfield First Assembly of God
Who: Children Grades PK4-6th
*
indicates required
Email Address
*
Parent Name
*
Child 1 Name
*
Child1 Birthday
*
Month
Day
Year
( mm / dd / yyyy )
Child 1 Grade (in the fall)
*
PK4
K
1st
2nd
3rd
4th
5th
6th
Address
*
City
*
State
*
Hm Phone
*
Cell
*
Emergency Contact
*
Emergency Contact Phone
*
Mother
Father
*
Home Church
*
Child 2 Name
Child2 Birthdate
Month
Day
Year
( mm / dd / yyyy )
Child 2Grade (in the fall)
PK4
K
1st
2nd
3rd
4th
5th
6th
Child 3 Name
Child 3 Birthdate
Month
Day
Year
( mm / dd / yyyy )
Child 3 Grade (in the fall)
PK4
K
1st
2nd
3rd
4th
5th
6th
Additional Information (Include Allergies)
