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June 8-12 from 6 - 9 p.m.
Please fill in all fields marked with a *
Child's Name *
Guardian / Parent *
Address *
Mailing Address
Home Phone
(xxx-xxx-xxxx)
Cell Phone
(xxx-xxx-xxxx)
*
Work Phone
(xxx-xxx-xxxx)
e-Mail *
Birthdate
(xx/xx/xx)
must be atleast 4 yrs old
*
Last Grade Completed
Medical Information: Please list medical or other information we need to know including any food allergies. *
Emergency Contact
(name and phone #)
*
Who will pick up your child at the end of each VBS day? *
Do you go to another church? yes no
If so, which church?
Can we photograph your child? yes no*
Can we use the photograph for the final day slideshow? yes no *