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Vacation Bible School

Welcome to our registration page for SonRise National Park VBS 2012 at Bethel Christian Reformed Church.  Please fill out the form below.  Required spaces are marked with a red asterisk.  If you are registering more than one child, please fill out a separate form for each child.   Thank you!

VBS REGISTRATION FORM:

1.

Did You Attend Last Year?
2.

How Did You Hear About Us?
3.
*

Date Of Birth
4.
*

Child's First Name
5.
*

Child's Last Name
6.
*

Street Address
7.
*

City
8.
*

State
9.
*

Zip Code
10.
*

Home Phone
11.

Cell Phone (if desired)
12.
*

Email Address
13.
*

Parent 1 Name
14.

Parent 2 Name
15.

Emergency Contact Name
16.

Emergency Contact Phone
17.

Allergies or Medical Conditions?
18.

Doctor Name
19.

Doctor Phone
20.
*

Last Grade Completed
21.

Home Church
22.

Any Additional Information We Should Know?

* Enter Your Email Address:

Type in the text that you see above:

  

Bethel Christian Reformed Church
521 S. Halleck St.
DeMotte, IN 46310
Phone: 219-987-2005
Fax: 219-987-7605
bethelcrc@netnitco.net

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