Wonder Junction at Russellville United Pentecostal Church

Street

Street 2

City

State/Province

Postal Code

Parent/Guardian First Name

Parent/Guardian Last Name

Primary Phone

Alternate Phone

Emergency Contact

Relationship to Student

Phone Number

First Name

Last Name

Gender

Male

Female

Birth Date

Age Group

Toddler Ages 2-3

Pre-Primary Ages 4-6

Primary Ages 7-9

Junior Ages 10-12

Food Allergies

Details

Medical Concerns

Details

I have more students to register

This site is protected by reCAPTCHA, and the Google Privacy Policy and Terms of Service apply.

Cancel

Register for VBS