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Pleasant Chapel VBS 2023
June 12-16
9:00 - 11:30 am
Registration Form
Please complete separate forms for multiple children
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* Indicates required question
Name of Child
*
Your answer
Street Address of Child
*
Your answer
City of Child
*
Your answer
State of Child
*
Your answer
Zip of Child
*
Your answer
Birth Date of Child
*
MM
/
DD
/
YYYY
Grade completed in school this year
Your answer
Parent/Guardian's NAme
*
Your answer
Parent's phone number
*
Your answer
Parent's email
Your answer
Is there Any important information we should know of your child (allergies, medical conditions, etc.)
Your answer
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