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Vacation Bible School Registration

July 17 - 21, 2017
9:00 a.m. - 12:30 p.m.

CONTACT INFORMATION
Child's Name(*)
Please let us know your child's name.

Parent or Guardian's Name(*)
Please give us your name or the parent's name

Address
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Email(*)
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Home Phone(*)
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Work Phone
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Cell Phone
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Birth Date(*)
Please indicate the child's date of birth

Last Grade Completed
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EMERGENCY INFORMATION
Emergency Contact 1(*)
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Emergency Contact 1 Phone(*)
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Emergency Contact 2
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Emergency Contact 2 Phone
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Medical Info and Allergies(*)
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Please include any food allergies

OTHER INFORMATION
Do you attend Church anywhere? If so, where?
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We will be taking pictures during VBS. Do we have your permission to use your child's picture on our website and Facebook? No names will be listed.(*)

Do we have permission to use your child's photo without their name?

Other information regarding your child that we should know
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