Donnels Creek Church of the Brethren
Register Me for 4-Day Kids Club (VBS)
Child's Name:
Gender:
Birthdate(dd/mm/yyyy):
Grade Completed:
Address:
City:
Zip:
Parents/Guardian:
Home Phone:
Cell Phone:
Work Phone:
Email:
Emergency Contact:
Relationship to Child:
Phone:
Home Church:
List:
Explain:
Food Allergies:
Medical Concerns:
In case of inclement weather, I ________________________________________ give permission for members of Donnels Creek to shuttle my child: __________________________________________
to the Donnels Creek Church of the Brethren and return the child to the Lawrenceville site.
Donnels Creek Church of the Brethren, 6562 Detrick-Jordan Pike, Springfield, Ohio 45502 (937) 964-8032
