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