Koza Baptist Church
On-line VBS Registration

 

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Summer, 2008

Complete the form to pre-register for Outrigger Island Vacation Bible School

NOTE:  VBS is for children who have completed
Kindergarten through 6th grade, but are not yet entered 7th grade.  

Please provide the following information (* indicates required fields):

     *Participant's Name (First & Last)
   
     Home/Quarters Address:
   
     *Mailing Address:
     (Include APO/FPO & Zip)
   
     *Home Phone Number
   
     Work Phone Number
   
     Cell Phone Number
   
     *Participant's Date of Birth

 

 

 
   
     *Last Grade Completed in School:
        (for school age children)		  
     *Emergency Contact #1
        (Name & Number)
     Emergency Contact #2
        (Name & Number)
     Medical or other info we may need to know:
        (please include any food allergies) 
     *Email Address:
   
     Parent/Guardian's Name:
   
     Who may pick up your child at the end of
     each VBS day?
     Do you attend Sunday School? School? Yes No
        If so, where do you attend?

 To complete the pre-registration process press "Submit Form" button.

P.O. Box 31 // Okinawa City Japan 904-0014 // 937-5036 // info@kozabaptistchurch.org