First Presbyterian VCS Registration

Power Lab

July 14-18, 2008

6:00 p.m. – 8:00 p.m.

Child’s Name:__________________________Gender__M__F

Age:_____*Date of Birth:________Last Grade Completed___

Child’s Name:________________________Gender__M__F

Age:_____*Date of Birth :_______Last Grade Completed___

Child’s Name:_________________________Gender__M__F

Age:_____ *Date of Birth :_______Last Grade Completed___

*Must be entering Kindergarten in the fall of 2008!

Parent Guardian ______________________________________

Street Address______________________________________

City/State/ZIP______________________________________

Home Phone__________Home e-mail Address_______________

Phone number where you can be reached during this time

_______________________________

Home Church ________________________________________

May we post your child’s photo on our website___yes___no

Allergies___________________________________________

Emergency Contact (if other than home phone):

Name/Phone_________________________________________

Brought by (if other than parent)

Name/Phone_________________________________________

I would like to order a devotional kit _____

I would like to order a CD _____

(check made out to First Presbyterian Church must be included with order)

Is there another VCS student you would like your child placed with? __________________________________________

Registration deadline-July 1, 2008!