VBS 2017 Registration Form
June 19 - 23, 6 PM - 8 PM | Adams Farm Community Church
5113 Mackay Road
Jamestown, NC 27282
For more information, contact us at 336.292.4565 or email KIDS@adamsfarmchurch.com
Please fill out one form per child.
Child's Name
*
Child's Age
*
Date of Birth
*
Last School Grade Completed
*
Please select one option.
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Select Option
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
School last attended
Mom/Guardian
*
Cell
*
Dad/Guardian
Cell
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Home Phone
*
Email
*
This address will receive a confirmation email
Emergency Contact
*
Phone
*
Relationship to Child
*
Allergies or Other Medical Conditions
Home Church
Friend you would like to be with
How did you hear about AFCC's VBS?
*
Submit
Description
June 19 - 23, 6 PM - 8 PM
Adams Farm Community Church
5113 Mackay Road
Jamestown, NC 27282
For more information, contact us at 336.292.4565 or email KIDS@adamsfarmchurch.com
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