Come join our fun-filled Science themed VBS!
Come join our fun-filled Science themed VBS! July 13-17, 2015 ~ 9:00am-12:00pm Registration Deadline: June 19, 2015 One form per child please Child’s name _____________________________________________________ Name your child would like to be called_________________________________ Grade entering in September 2015____________________________________ Date Of Birth ________________________ Age ________________________ Parents’ names ___________________________________________________ Email ___________________________________________________________ Address _________________________________________________________ Home phone _____________________________________________________ Cell phone(s) _____________________________________________________ Emergency contact person# _________________________________________ Relationship to student _____________________________________________ Food allergies Y/N (List) ____________________________________________ Medical concerns Y/N (Explain)_______________________________________ ________________________________________________________________ Family doctor _____________________________________________________ Doctor’s Phone #__________________________________________________ Others permitted to pick up my child: __________________________________ ________________________________________________________________ Registration Fee $50/child ~ Children entering PreK 4 - 4th grade Make checks payable to: Our Lady of the Lake Church, Memo: VBS 2015 Mail or drop off to: Our Lady of the Lake Church, 294 Sparta Ave., Sparta, NJ 07871 If you have any questions, or if you would like to volunteer (those entering 6th grade through adult), please contact: Kristi Carlucci 973-568-8971 or [email protected]
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