Jerusalem Marketplace

Vacation Bible School

Registration Form (one per family)

9am-12pm July 28^th- Aug 1st, 2008

Please print and put in church office or mail to:

St. George’s Episcopal Church

19167 Poplar Hill Lane

Valley Lee, MD 20692

301-994-0585

Name and Age: __________________________________________________________________

__________________________________________________________________

Parent’s Name(s): ____________________________________________________________________

Street Address: ______________________________________________________________________

City: _______________________ State: ________ Zip: ________

Home telephone: (______) ________________ Cell telephone: (_____) _____________________

Home Email: _________________________________________

Other Emergency Contact (name and phone): ______________________________________________

Will parents be helping in other areas of Jerusalem Marketplace? _______ If so, where? ________________

Allergies or other medical conditions: _____________________________________________________

___________________________________________________________________________________

Home church (if any): _________________________________________________________________

I understand that images of my child may be used for VBS promotion including, but not limited to, video presentations,
church newsletters and bulletin boards, and newspaper inclusions. I give permission for the above named children to
be included in group pictures.

Guardian’s Signature _____________________________________ Date ______________

Children need to be 4 years old to participate. Questions?

Call Ruth Ann Knave 301-862-3268

Please register early, space is limited to 50 children