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VBS 2019 Registration Form
Lauderhill Seventh-day Adventist Church
Monday, June 24 – Friday, June 29
8:00 am – 2:00 pm
For ages 4–14
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* Indicates required question
Child's Name (One form per child)
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Child's Age
*
Your answer
Grade Entering
Your answer
Parent/Guardian Name(s)
*
Your answer
Child's Address - Line 1
Your answer
Child's Address - City
Your answer
Child's Address - State
Your answer
Child's Address - Zip
Your answer
Contact Phone Number (include area code)
*
Your answer
Secondary Phone Number
*
Your answer
Contact Email Address
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Name of person picking up child
*
Your answer
How will your child go home (car, bus, walk, etc.)?
Your answer
Please list all allergies and/or medical concerns:
Your answer
How did you hear about VBS?
Your answer
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