Vacation Bible School—Online Registration

Whitehall Mennonite Church & Egypt Community Church Presents...

Vacation Bible School, July 27 - July 31, 6:30 - 8:30 pm
Location: Whitehall Menonite Church,
4138 Wilson Street,
Whitehall, PA 18052

Child's First name: Last name:
Date of Birth: Age: Sex:Male Female
Child’s Grade (Fall 2015):
Child’s Address:

Parent's/Guardian’s Name:
Parent's/Guardian’s Phone: Cell Phone: Email:

Person to be contacted in case of emergency:
Name: Phone: Relationship to Child:

Does your child have any medical condition(s) that we should be aware of? (Allergies, medications, etc.)
Please explain: