CCEA Sponsored Vacation Bible School Preregistration

Your email address:
Child's Name:
Street Address:
City:
State:	Select a state... MD DE PA	Zip:
Home phone:
Birth Date:
Grade:	Select a grade... Entereing preschool in September Entering kindergarten in September Entering 1st grade in September Entering 5th grade and up in September
Parent/Guardian's Name:
Emergency contact phone number:
My child requires transportation from Trinity United Methodist Church in Chesapeake City to the VBS at Town Point United Methodist Church.
Allergies or Other Special Needs:
Home Church:
Other Children your child would like to be with:
=required