REGISTRATION FORM FOR CHRISTMAS VBS

AT ALBIA BAPTIST TEMPLE

624 A AVE WEST

ALBIA, IA.  52531

Date of VBS:    December 27-28th 2018

Time:               8:00 am – 3:00 pm

Location:         624 A Ave W.  Albia Ia.  52531

All children in Kindergarten through 6th grade are welcome to attend.

My child(ren) will be attending the VBS.

            Name:_________________________          Grade: _____________

            Name: _________________________          Grade: _____________

            Name: _________________________          Grade: _____________

            Name: _________________________          Grade: _____________

            Name: _________________________          Grade: _____________

Name of Parent or guardian: ________________________________

Home address:  Street _____________________________ 

City ______________State ___         Zip ______

                        Contact number:  _____-_____-_________

Emergency contact:  Name: _______________________  Number: ____-____-______

Allergies:         __________________________________________________________

Note about breakfast:  Breakfast will be served from 8:00 – 8:45 am.  Your child can arrive in that time slot and have breakfast.  Program begins at 9:00 am both days. 

Special instructions concerning my child(ren):  ____________________________________________________________________________________________________________________________________________________________

Parent or guardian’s signature:  _________________________________ Date: ____-____-____

PLEASE HAVE REGISTRATIONS TO THE CHURCH BY DECEMBER 22nd 2018.