VBS 2004 Registration


Last Name:           First Name:

Date of Birth:           Age in Sept 04:           M/F:

Home Address:

City:           State:           Zip Code:

Home Phone:           Cell Phone:

Work Phone:           E-mail:

Registration Fee: $10 per child
Please make check payable to OCM Grace Church and send to:
OCM Grace Church
VBS 2004
P.O. Box 536
Tenafly, NJ 07670