Tulsa Chinese Christian Church
1430 South 131st East Avenue
Tulsa, OK  74108
(918) 438-6449

July 17 – 21, 2017
9 am – noon
www.tulsaccc.org

VBS Registration Form

Child’s name:_____________________________________________ Child’s gender: ____________

Child’s age:________ 	Date of birth:________________ 	Grade entering:________

Name of parent(s):___________________________________________________________________

Street address:______________________________________________________________________

City:__________________________________________ State:_________ ZIP:___________________

Home telephone (_______)____________________________________________________________

Parent/caregiver’s cell phone (_______)_______________________________________________

Home email address:_________________________________________________________________

Home church: _______________________________________________________________________

Allergies or other medical conditions:_________________________________________________

In case of emergency, contact:______________________________________________

Phone: ____________________________________________________________________

Relationship to child:__________________________________________________________