Donnels Creek Church of the Brethren
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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:
Free to all 1st - 6th Graders
Tuesday thru Friday - 6:30 - 8:30 pm
June 21th - 24th, 2022
2022 4-Day Kids Club(VBS)

Free
 BIBLE STORIES
 BIBLE STORIES
Games
    Snacks
Games
    Snacks

Free

Free

Free
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
www.donnelscreekchurch.org
Male
Yes
No
Yes
No
Female