2023 Beavertown GMC VBS Registration Form

June 30-May 2, 6pm-8:15pm | Please fill out the form completely and then click "Submit"!

Please note, you will need to fill out a registration form for each child who is planning to attend.

If you have any questions, please contact our registrar, Julie Witmer, by call or text @ 570-541-8542.

Child's Name:

*

Child's Age Range (Check One):

*

Please select all that apply.

3-4 Years 5-8 Years 9-12 Years 13-18 Years

Parent/Guardian's Name:

*

Email Address:

*

This address will receive a confirmation email

Phone (also used for emergency contact.)

*

Address:

*

Transportation:

*

Please select one option.

Yes, I want bus transportation! No, we will provide our own transportation.

Which days will you be attending? (Choose all that apply.)

*

Please select all that apply.

All of them! Tuesday Wednesday Thursday Friday

Please list any food allergies or other things we should be made aware of:

Description

June 30-May 2, 6pm-8:15pm

Please fill out the form completely and then click "Submit"!

Please note, you will need to fill out a registration form for each child who is planning to attend.

If you have any questions, please contact our registrar, Julie Witmer, by call or text @ 570-541-8542.

Please Fix the Following

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