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2017 LHBC VBS REGISTRATION
#findyourhero
2017 LHBC VBS
2957 Mt Carmel Road
Hampton, GA 30248
libertyhillbc.net
Child Information
First Name
*
Last Name
*
Gender
*
M
F
Birth Date
*
+
Age/Grade
*
Pre-K 3
Pre-K 4
Pre-K 5
Kindergarten
1st
2nd
3rd
4th
5th
Other
1st Track Choice (Graded)
Archery
Guitar
Dance
Science Experiments
Choir
Pinewood Derby Racers
Arts and Crafts
2nd Track Choice (Graded)
Archery
Guitar
Dance
Science Experiments
Choir
Pinewood Derby Racers
Arts and Crafts
3rd Track Choice (Graded)
Archery
Guitar
Dance
Science Experiments
Choir
Pinewood Derby Racers
Arts and Crafts
1st Track Choice (Pre-K)
Color Bells
Puppets
Arts and Crafts
Dance
Choir
2nd Track Choice (Pre-K)
Color Bells
Puppets
Arts and Crafts
Dance
Choir
3rd Track Choice (Pre-K)
Color Bells
Puppets
Arts and Crafts
Dance
Choir
Parent/Primary Contact Information
Relationship to Participant
*
Mother
Father
Grandmother
Grandfather
Guardian
Other
Other
First Name
*
Last Name
*
Address 1
*
Address 2
City
*
State
*
Zip
*
Cell Phone
*
Home Phone
Email Address
*
Please Confirm Email Address
*
Allergy Information
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