Please submit one form per child. Pre-Registration for VBS 2008 The United Church of God 1211 Fairmont Drive Harrisburg, PA 17112 August 7, 8 & 9, 2008. 8:45am to 4:00pm. For kids ages 3 to grade 6.   Child's First Name Child's Last Name Street    City State    Zip 3 4 5 6 7 8 9 10 11 12 January February March April May June July August September October November December None Preschool Kindergarden First Second Third Fourth Fifth Sixth Age       Birth Month Grade Completed Parent's Name Daytime Phone # Emergency Contact Phone #   Does your child have any special dietary needs?   Does your child have any allergies (food, insects, etc.)?   If your child may need any medications during VBS, please list them and when they should be taken:   Please list any other special needs or other info we should know:   Will you need to drop off your child early? No Yes If Yes, Morning Drop Off Time:      Child care will not begin before at 7:00 A.M. Which days? Thursday Friday Saturday   Will you need to pick up your child late? No Yes If Yes, Evening Pick-Up Time:      Child care will not continue beyond 5:30 P.M. Which days? Thursday Friday Saturday   Who is permitted to pick up your children?   Your E-mail Address (will not be used for solicitation)

Please remember two things: Please have your child bring a Bible. If your child doesn't own their own copy of a Bible, we will provide one for free, just tell us at the registration desk upon arrival. Please have your child bring a beach towel with their name labeled on it. Your child will be in the care, guidance and love of those serving during VBS. Thank you for allowing your child the joy of learning about Jesus. Please contact the church office at 652-2418 if you have questions beyond the scope of the VBS website or to correct/update your registration.