Westgate Memorial Baptist Church

Registration-Children K-6

Marketplace A.D.
Vacation Bible School 2012

Westgate Memorial Baptist Church
6220 Westgate Drive - Beaumont
June 11 – 15, 2012
9:00 a.m. - 12:00 p.m.

Pre-Registration required, call 866-3417
Or register online at www.westgatechurch.com
For kids that have completed Kindergarten through 6th grade

Deadline for Registration - June 3, 2012

VBS Registration Form

Name: *
Gender: *
School Grade Completed: *

Address: *
City: *
Zip Code: *

E-Mail: *
Phone #: *
Phone 2 #: *

Age: *
Birthday: *
Father's Name: *
Mother's Name: *
Church's Affiliation: *

Request to be with friend
1st choice: *
2nd choice: *
We will try our best to place you with one another

Allergies or Medical Instructions:

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* Mandatory fields.