Lake Center Bible Church will be running a 5 day Vacation Bible School Program in the Portage Terrace Mobile Home Community on July 14th - 18th, 2009, from 4:00 - 6:00pm. If you would like your child to participate, please complete the following form. If you have any questions, contact Mark Vanderklok.

Your Name (Parent)
Email Address
Home Address
Phone Number
Emergency Contact Number
Name of Child / Children Attending
Any Allergies or physical limitations?
List anyone who is NOT permitted to pick up your child
I understand that Lake Center is not liable for any injuries that may occur	I agree
I give permission to Lake Center to use pictures of my child	Yes No
Image Verification Please enter the text from the image [ Refresh Image ]