EGYPT COMMUNITY CHURCH 2021 VBS REGISTRATION FORM
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* Parent Name:
* Street Address:
* Phone:
* Email Address:
* Emergency Contact Name & Number: 
* Child Name(s) / birthdate / grade in school / sex
Any Food Allergies?
Insurance Info:
Permission to use your child's photos?
Name, number & relationship of others permitted to pickup your child:
Church Membership:
* City:
* State:
* Zip code:
Child's physician's name, phone: 
Other, name:
What: Vacation Bible School
Where: Egypt Community Church
            4129 S, Church St.
            Whitehall, PA. 19052
When:  August 2nd – 6th
            6:00pm - 8:30pm
Who:    Ages 5 through 5th grade
Wear:   play clothes & sneakers
Snacks provided
Register online: egyptcc.org
Info call: 610-262-4961
NOTE: All teachers and workers in                    contact with children have                      background clearances.

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Egypt Community Church