Vacation Bible School
Cokesbury’s 2019 VBS “To Mars and Beyond”
June 24-28 2019, 6 pm to 8:30 pm Monday thru Friday, Final Program 10am, Sunday, June 30th
Please join us for Crafts, Science, Play, Snacks!
Ages Pre-K to 8th grade
Register online https://www.myvbs.org/centrepreschurch/ or email betz721@gmail.com  with the below detail Betsy at 717-487-8072.

June 24-28th, 6-8pm 83 New Park Rd., New Park PA  17352

Student’s Name: ____________________________________________________________________

Parent/Family/Guardian Name:  _______________________________________________________

Address: ____________________________________________________________

City:  ___________________________   State: _________ Zip: ________________

E-mail Address:  ______________________________________________________________

Phone Numbers:  Home: __________________   Cell: _________________ Work: __________________

Student’s Date of birth: _____/_____/_____   Age: _______ Last school grade completed: ___________

Home Church (if any):  __________________________________________________________________

Friends of your child at Centre:  ___________________________________________________________

Special Needs/Allergies/Medical Information/Other:   _________________________________________

_____________________________________________________________________________________

Emergency Contacts

Name ____________________________________         Phone ______________________________

Name ____________________________________         Phone ______________________________

Name(s) of person(s) who may pick up this child from VBS: _____________________________________

_____________________________________________________________________________________

Photo Release:   Centre Presbyterian Church/VBS has my permission to use my child’s photograph publicly in VBS materials. I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Parent/Guardian’s signature: _______________________________________ Date_________________

 

For additional information contact Betsy at (717)487-8072 or email betz721@gmail.com

– – – – – – – – – – – – – – – – – – – (for church use only) – – – – – – – – – – – – – – – – – – – – –

Assigned to Voyager Group:  _________________________________________________________________________________

Are family members helping with To Mars and Beyond?       Yes No

If yes, where?  ______________________________________