Fanwood Presbyterian Church
Vacation Bible School
July 25– July 29, 2011
9:00 am – 12:30 pm
4 years old by 10/1/11 to those entering 4th Grade
Parent’s Name _________________________________________________________________
Street Address/Town/Zip _________________________________________________________
E-mail Address_________________________________________________________________
Home phone number ____________________ Cell phone number _______________________
Emergency Name/Telephone _____________________________ ________________________
Church Affiliation ______________________________________________________________
Student’s Name
(4yrs by 10/1/11 to
entering 4th Grade) Birth Date Grade in September School attending
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Other than myself, name of person(s) who may pick up this child(ren) from VBS
______________________________________________________________________________
Anything special we should know? (allergies/medical concerns)
______________________________________________________________________________
Parent’s Signature ________________________________________ Date __________________
Please return to: Registration Fees:
Fanwood Presbyterian Church—VBS 1 child $25.00
Box 69 2 children $40.00
Fanwood, NJ 07023 Family fee $60.00
Enrollment is limited, so register early. Deadline for registration is June 1, 2011.
Make checks payable to Fanwood Presbyterian Church. For more information, please contact the church office at 908-889-8891.