Register your child for Power Lab!

First Child's Name:

Second Child's Name (leave blank if non-applicable):

Third Child's Name (leave blank if non-applicable):

Parent Information

Parent Guardian

Parent/Guardian Name:


Address:

City: State: ZIP:

Phone Number :
E-mail:

Do you attend church regularly? Yes No
------If yes, where?

How did you hear about our VBS?
I attend this church Church advertisement
I am a friend of who attends this church.

Medical Information

Emergency Contact Information

First Emergency Contact:

Second Emergency Contact:

In the event of an emergency that I/we cannot be reached,
please contact other persons authorized to pick-up my child:

Pick Up Schedule

I want to pre-order the Power Lab CD (only $7)

Additional notes: