2011 Vacation Bible School

June 20-24 / 9am to noon

St. Elizabeth of Hungary / Pflugerville, TX

Registration Form (One Per Family)

Early Registration Deadline May 15; Cost increases $5 per child after May 15

FIRST NAME LAST NAME AGE GRADE

FALL 2011 Shirt Size

S/M/L/AS/AM Cost

1. $25

2. $15

3. $15

4. $15

5. N/C

YES, I would like to order __________ Music CD @ $10 each Total Due $___________

Parent/Guardian Name:

Mailing Address:

City: State: ZIP:

Cell (____) Home Phone: (_____)

E-mail address:

In case of emergency, contact: Phone______________________

Allergies or other medical conditions: _____________________________________________________________________

Note: Registrations received after June 1 are not guaranteed a t-shirt.

Volunteer Discount / $5 per child

Escuela de Biblia de Vacaciones 2011

20-24 de Junio

St. Elizabeth of Hungary / Pflugerville, TX

Forma de Registro (Uno por famila)

principios fecha Registro 20 Mayo; Aumento osto $5 per nino after 20 de Mayo

Nombre e Inicial Apellido Años GRADO 2011

Camisa S/M/L/AS/AM

Precio

1. $25

2. $15

3. $15

4. $15

5. N/C

SÍ, Me gustaría orden __________ Música CD @ $10 each COSTO $___________

Nombre Padres __________________________________________________________________________________

Direccion:__________________________________________________________________________________________

Ciudad: ___________________________________________ Estado: __________ Zip: _________________________

Telefono Casa: (_______) _________________________Numero Alterno/Celular: (____)___________________

Correo Electrónico: ________________________________________________________________________________

Contactos En Caso De Emergencia: _______________________________________________________________

Relación Al Niño: __________________________________________________________________________________

Requerimientos De Ensenanza Especiales Alergias O Requerimientos Nutricionales Especiales?

____________________________________________________________________________________________________