| Senatobia Church of Christ |
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| VBS Registration
Form |
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| July 7-11,
2008 9:00-12:00 4K-6th Grade |
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| Child's Name |
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| Birth Date |
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| Age |
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| Last Grade Completed |
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| Parents' Names |
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| Address |
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| City/State/Zip |
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| Home Phone |
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| Cell Phone |
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| Work Phone |
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| Church Home |
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| Emergency Contacts: |
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Phone Number |
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| Allergies/Medical
Information /Other Concerns |
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| Dismissal
Release Information: |
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| Names
of persons who may pick up this child from VBS each day |
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| My
child has my permission to attend and participate in I am a piece of God's
puzzle VBS |
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| program and
their picture to be taken and used in for the purpose of VBS material. |
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| Parent Signature |
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| Application and t-shirts are free. If
you have any questions you
may call the |
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office at 662-562-6331 or Gloria at 662-561-2910. |
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| Cirlce
T-shirt size - Youth XS S
M L XL |
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| Adult S
M L XL
2XL |
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