Marlton Assembly of God
Vacation Bible School


June 23 - 27, 2008 ● 6:30 - 9:00 PM
Ages: 3 - 11


@

Marlton Assembly of God
625 East Main St.
Marlton, New Jersey 08053
(856) 596-1011

To Register:
Please fill in the required information then press "SUBMIT" at the bottom of the page.
Fill out the form again if you have more then three (3) children attending.

* = Required Field Entry

 
 Family Information:
Parent or Guardian Full Name*:
Address*:
City*:
State:
Zip*:
Phone Number*: (example: 856-596-1011)
Work Number:
Cell Number:
E-Mail Address*:
Emergency Contact:
Emergency Phone:
Would you like to receive our newsletter?  
 First Child's Information:
Child's Full Name*:
Date of Birth*:   (ex: mm/dd/yyyy, 06/23/2008)
Age (as of June 23rd)*:
Grade Completed*:   (example: pre, K, 1st, 2nd, 3rd, 4th)
Allergies or Other Concerns:
 Second Child's Information:
Child's Full Name:
Date of Birth:   (ex: mm/dd/yyyy, 06/23/2008)
Age (as of June 23rd):
Grade Completed:   (example: pre, K, 1st, 2nd, 3rd, 4th)
Allergies or Other Concerns:
 Third Child's Information:
Child's Full Name:
Date of Birth:   (ex: mm/dd/yyyy, 06/23/2008)
Age (as of June 23rd):
Grade Completed:   (example: pre, K, 1st, 2nd, 3rd, 4th)
Allergies or Other Concerns: