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Participant Registration

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Redeemer PCA

Location

11412 Strickland Rd

Raleigh, NC 27613

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Contact Brook Hagan:

919-518-2370

office@redeemerpca.net

First, Tell Us About Yourself:

Parent Information

Thank you for your interest in our Wait List! Please complete this form and a member of our VBS Crew will contact you if a spot opens up for your child.

First Name

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Last Name

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Contact Phone

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Emergency Contact FN & LN

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Emergency Contact Relationship

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Emergency Contact Phone

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Street Address

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City

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ZIP/Postal Code

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Home Church Affiliation

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Tell Us About Your Participant

Which session will they be attending?

First Name

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Last Name

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Gender

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Date Of Birth

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Grade Entering

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Allergies

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Medical Concerns

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

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Friend 1 FN & LN

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Friend 2 FN & LN

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Comments

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