New Page — New Era Reformed Church

VBS Online Enrollment Form for 2019

Parents Full Name *

Parents Full Name

First Name

Last Name

Telephone Number

Please put a number to contact you should a need arise.

Emergency Contact Information *

Please include a number where we can call you should the need arise. Also include if this is a home number or work.

Names and Ages *

Please include full names and ages for all the children attending. Please include any special considerations for the child that need to be brought to our attention (including medical conditions that might arise such as asthma or allergies).

Future Communication

Please include an address or email that we can contact you for future events.