Galactic Blast VBS Registration

To register your child for Galactic Blast VBS 2010 at New Horizon Community Church, simply fill out the form below and click REGISTER. You MUST submit a separate form for each child being registered.

The cost to register each child is US $20 (due on the first day of VBS).
For families that can not afford this, there are some scholarships available.
Please indicate below, if you would like to be considered for a VBS scholarship.

Fields marked with an asterisk (*) are required.

Scholarship:	No Yes
*Child's Name:
Gender:	Male Female
*Potty Trained:	No Yes
*Parent/Guardian:
Address:
*E-mail Address:
*Phone Numbers
Home:
Cell:
Work:
Age Information
Date of Birth:	,
*Age:
Last school grade completed:
*T-Shirt Size:
Home Church:
Allergies, Medical Information, Other:
Emergency Contacts
Contact 1:
Contact 1 Phone:
Contact 2:
Contact 2 Phone:
Dismissal Information:	Name(s) of person(s) who may pick up this child from VBS: