First Presbyterian Church presents:

July 26-30 6:00-8:15 p.m.

for children ages Preschool (age 3) through completed 5^th grade.

 Power Lab Registration Form
     (one per family)

Name & Age of Child:

Street Address:

City, State, ZIP:

Home telephone:                             

Your Cell/Work Phone:

Home E-mail:

Number of family members participating in VBS:

Will parents be helping in other areas of VBS? Where?

In case of emergency, contact:

Allergies or other medical conditions:

Home church (if applicable):

Name of a special friend your child might like to be with: