Jim Newsome – Friedberg Moravian Church

Staff

Senior Pastor

Ext. 1001

Please fill out a seperate registration form for each child/adult who wishes to participate in Vacation Bible School.

First Name

Last Name

Age (child only)

Grade Last Completed (child/youth only)

Gender

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip Code

Phone (required

Siblings Attending VBS (child/youth only)

Home Church (optional)

Allergies or Special Needs (optional)

Emergency Contact Name (child/youth only)

Emergency Contact Phone

Relationship to Child