Wufoo

VBS REGISTRATION

Pre-register here for VBS
Yokota Baptist Church
Dino Detectives
August 4 -8, 2008 from 6 to 8 pm
(For ages 4 through 12)

Father’s/Guardian Name: Title First Last Suffix
Mother’s /Guardian Name: Title First Last Suffix
Phone Number: *
E-Mail Address: *
Home Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Student Name: Title First Last Suffix
Age Group: (age as of August 1, 2008) *
4-5 6-7 8-9 10-12
Extra- Allergies/Medical Information or Special Needs.
Do Not Fill This Out