Join us June 24-28, 2018 from 9am-12pm NorthRidge Church 2250 State Road 17 S Haines City, FL 33844 www.northridgehc.com northridge@northridgehc.com * indicates required field Parent/Guardian Name* Phone Number during VBS* Email:* Child's Name* Child's Date of Birth* Grade Completed* K-5 1st 2nd 3rd 4th 5th 6th Physical Address* City* Zip* Persons who can pick up child from VBS* Emergency Contact:* Emergency Contact Phone Number* Please list any allergies* Please list any medications* Does your family attend church regularly?* Yes No Name of church CAPTCHA Code:*
