June 4 - 7, 2023 |  6:00 PM - 8:00 PM

First Wesleyan Church BC
510 E. Alabama Ave
Bessemer City, NC 28016

The information below will only be shared with Michelle Owens for VBS registration and emergency contact.  

Please fill out one form per child.

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* 1. Child's Name

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* 2. Date of Birth

Date

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* 3. Last Completed School Grade

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* 4. Parent / Guardian Name (First & Last)

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* 5. Parent / Guardian Phone Number

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* 6. Address

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* 7. Emergency Contact and Phone Number

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* 8. Allergies or Other Medical Concerns

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