August 18-229:00 AM- 1:00 PMAges 5-13519 Kennedy St. Palmyra, NJ 08065 Racers Name * First Name Last Name Racer Date of Birth * MM DD YYYY Racer Age * Parent Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Cell Phone Number * Email * Emergency Contact Name * First Name Last Name Emergency Contact Phone Number * (###) ### #### Please list any Allergies & Food Restrictions * I give permission for the following people to pick up my child from VBS * I give permission for my child to be photographed for public publications. Not limited to church website, social media and publications. * Yes No Does racer need transportation? * Yes No Thank you!
