Wesley United Methodist Church  -  3701 Conduit Rd.  Colonial Heights, VA  23834

Church Phone (804)526-3700  -  Afterschool Phone (804)526-3757

WebMaster :  john.lee@comcast.net

3's, 4's & 5's, Kindergarten & 1st Grades,

2nd & 3rd, 4th & 5th grades

VBS 2010

August 1 thru August 5

6:00 pm to 8:30 pm

First Name

Last Name

AGE

Grade of last school Year

Address

City

State

Zip

Parent First Name

Parent Last Name

Phone Number

(804)526-3700 format

Cell Phone Number 1

(804)526-3700 format

Cell Phone Number 2

(804)526-3700 format

List all allergies

Emergency Information if other than Parent(s)