River Rock Kids VBS Student Registration Form
June 19th, 20th, 21st (Wednesday through Friday) 9:00-11:30am Ages 4 years old - 12 years old
Student Name
First Name
Last Name
Parent Name
First Name
Last Name
Parent Email
example@example.com
Parent Phone Number
Age of student
If your child has a food allergy, please list below
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Comments
Submit Application
Clear Fields
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