Please, take the time to register all children separately for VBS @ Eastern Heights Christian Church 5100 Lake Rd.

Student's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home/Cell Phone

(###)

###

####

Parent/Guardian's Name

First Name

Last Name

Parent/Guardian's Email

Emergency Contact Number

(###)

###

####

Allergies/Special Needs

Grade your child is Entering next year

Student's Tee Shirt Size