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Participant Registration

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Puckety Presbyterian Church

Location

1009 Puckety Church Road

Lower Burrell, PA 15068

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Contact Debra Artman:

724-882-4531

artmand@comcast.net

First, Tell Us About Yourself:

Parent Information

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Country

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Contact Phone 1

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Contact Phone 2

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Any other adults authorized to pick up your children

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

First Name

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Last Name

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Grade Entering

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Gender

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Date Of Birth

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Allergies

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Medical Concerns

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Comments

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Photo Release: Pictures taken during VBS can be used IN HOUSE or on our social media - Facebook, Instagram, etc. (no names/just pictures)

I acknowledge and give permission that pictures of my child(ren) may be used IN HOUSE and online via Puckety website, Puckety Facebook, and via Zoom

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I would like to be on the Puckety email list to receive notices of other activities such as Trunk or Treat, Easter Egg Hunt, etc.

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