2009 Vacation Bible School - Boomerang Express
July 27-30, 6:30pm - 9:00pm
(for children who have completed Pre-K through 5th Grade - Please No Exceptions)

Please complete the online VBS 2009 Registration Card or Download the PDF form, complete and fax back to the church at 972-285-6043.
E-mail address*
Child's Name*
Gender* Boy Girl 
Birth date*

Age*
Last Grade
Completed*
Address*
City*
Zip*
Home Phone*
I attend church: Sometime Never Every Sunday Often
Where?
Parent's Name(s)*
In case of 
emergency 
contact*		 @
If serving as a VBS worker please indicate where
Allergies or 
Additional 
Information
  I have read the statement below and agree to the
       conditions listed.*

I hereby give my permission for my child to participate in the
special events during Vacation Bible School. I hereby authorize
the staff of Mimosa Lane Baptist Church to obtain emergency 
medical treatment for my child should he/she become ill or injured.

*Required Fields

 

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Mimosa Lane Baptist Church - 972-288-7426 - info@mimosalane.org