JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Salem Church VBS Registration
July 19-21, 2021 6:30 pm - 8:30 pm
Salem Church, 2150 Route Old 22, Lenhartsville, PA 19534
Ph: (610) 562-5033
Email: wearesalemchurch@gmail.com
Website:
www.wearesalemchurch.com
Please complete all of the below items. Thank you!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your Name (Legal Guardian)
*
Your answer
Cell number
*
Your answer
Email address:
*
Your answer
Child #1 Name:
*
Your answer
Child #1 - Grade just completed
*
N/A (Pre-school)
Kindergarten
First
Second
Third
Fourth
Fifth
Child #2 Name:
Your answer
Child #2 - Grade just completed
N/A (Pre-school)
Kindergarten
First
Second
Third
Fourth
Fifth
Clear selection
Child #3 Name:
Your answer
Child #3 - Grade just completed
N/A (Pre-school)
Kindergarten
First
Second
Third
Fourth
Fifth
Clear selection
Child #4 Name:
Your answer
Child #4 - Grade just completed
N/A (Pre-school)
Kindergarten
First
Second
Third
Fourth
Fifth
Clear selection
If you have additional children, please list them here by name and grade completed.
Your answer
Do any of your children listed above have food allergies? Please reply "none" or list the child(ren) and type of allergy.
*
Your answer
Please provide an alternative emergency contact name:
*
Your answer
How is the above person connected with your family? (e.g. aunt, friend, neighbor, etc)
*
Your answer
What is the emergency contact's cell number?
*
Your answer
How did you hear about our Vacation Bible School?
*
We attend Salem Church.
We were invited by a church family.
We noticed your sign on church property.
We noticed your sign on private home yard.
Please provide your mailing address.
*
Your answer
Finally, please type in your full name to indicate you are the guardian of above named child(ren) and you are granting permission for them to attend Vacation Bible School at Salem Church. Thank you!
*
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
