Child's name: Date of birth: Last completed school grade: Street: City: State: ZIP: Phone: Email: In case of emergency, contact: Relationship to child: Phone: Father: Mother: Allergies or medical conditions we should be aware of: Your home church: Has this child ever attended our VBS before? Yes No
Child's name:
Date of birth: Last completed school grade:
Street:
City: State: ZIP:
Phone: Email:
In case of emergency, contact:
Relationship to child: Phone:
Father: Mother:
Allergies or medical conditions we should be aware of:
Your home church:
Ledgewood Baptist Church 233 Main Street Ledgewood, NJ 07852 973-584-2677 www.ledgewoodbaptist.com Rev. David Holwick, dholwick@gmail.com VBS director: Pam Freund