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Emmanuel VBS 2021
Please complete this form for each child that you wish to register. If you are registering more than one child, you may submit multiple forms.
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Email
*
Your email
Child's Name
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Grade Entering (2021-22 School Year)
*
1st grade
2nd grade
3rd grade
4th grade
5th grade
Parent/Guardian Name
*
Your answer
Postal Address
*
Your answer
Phone Number
*
Your answer
Please describe any allergies or other special needs your child may have
Your answer
Emergency contact (other than parent listed above)
*
Your answer
Emergency contact phone number
*
Your answer
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