Mt. Pisgah Wesleyan Church
A Mountaintop Experience in the Love of God

 


 


Online Registration for VBS 2010

 

 VBS Registration

Child's Information
First Name:
Last Name:
Birth Date:
Age:
Grade:
Name of Siblings
Attending VBS:

Parent Information
Home Church (If Applicable):
Parent Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Daytime Phone:
Evening Phone:
Cell Phone:
Email:
Child's
Allergies/Health Conditions:
Comments:

 


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