SPECIAL NEEDS VACATION BIBLE SCHOOL 2019 REGISTRATION FORM

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Special Needs Vacation Bible School will be held August 5th - 9th, 2019 with an option of either 9am - noon each day (with lunch included) or 5 - 8pm each day (with dinner included). Please fill out the form below to reserve your child’s spot. A confirmation will be emailed within a week.

Please contact Judi Cooper with any questions at jhangen@kofk.org

King of Kings Lutheran Church 4025 Kings Way Fairfax, Virginia

Child's Name *
Child's Name
Parent's Name *
Parent's Name
Address *
Address
Cell Phone *
Cell Phone
Emergency Contact *
Emergency Contact
Emergency Contact Cell *
Emergency Contact Cell
Person Responsible for Pick Up *
Person Responsible for Pick Up
Phone Number for Pick Up Person *
Phone Number for Pick Up Person