St. Mark’s Lutheran Church

508 Harry Street

Conshohocken, PA 19428

 

“Baobab Blast”

 

Yes!  Sign us up for Vacation Bible School!

July 26th – July 30th  at 6:30 – 8:45 PM

Cost:  FREE

 

Student’s Name_______________________________________


Birth date_____________ Last Grade Completed____________

 

Known Allergies or medical concerns: ___________________

_____________________________________________________

Parent’s Name (s):_____________________________________ _____________________________________________________

Address: ____________________________________________
_____________________________________________________


Home Phone: ______________  Cell Phone: ______________

 

Email address:_______________________________________

 

Emergency Contact (relationship) and phone #:____________ _____________________________________________________
Health Care Professional-Name and Phone: _______________
_____________________________________________________

 

Please return this completed form to St. Mark’s Lutheran Church,

508 Harry Street, Conshohocken, PA 19428.  Thank you!

See www.stmarksconshy.org if you need additional forms.