JY Summer Safari Registration

Summer Safari

A VBS for youth going into
4th—8th grade

July 15th-18th, 2013
9am to 4pm Monday—Friday

Cost is $15 per youth – Lunch Provided

Summer Safari

Summer Safari Registration Form

Youth's Name*
FirstLast
Youth's Cell Phone
(###) ###-####
Youth's Email
Fall Grade Level*
Address*
Street AddressCityStateZIP Code
Home Phone
Mother's Name
FirstLast
Mother's Phone
(###) ###-####
Mother's Email
Father's Name
FirstLast
Father's Phone
(###) ###-####
Father's Email
Volunteer/Drivers
- I am willing to volunteer/drive for this event
Registration Fee Agreement*
- I agree to pay the registration fee within a week of this registration.

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