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Adventure Island VBS Registration Form July 12th-16th, 6:30-8:30pm
Jefferson Ruritan Community Center - Contact: Brenda Price, 301-473-5082,
bsprice44@comcast.net
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ADVENTURE ISLAND
Explorers Name (Your child)
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Your answer
Date of Birth
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DD
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YYYY
Age of Child
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Your answer
Last Grade Completed
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Your answer
Explorers Name (Your child)
Your answer
Date of Birth
MM
/
DD
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YYYY
Age of Child
Your answer
Last Grade Completed
Your answer
Explorers Name (Your child)
Your answer
Date of Birth
MM
/
DD
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YYYY
Age of Child
Your answer
Last Grade Completed
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Parent/Family/Guardian Name:
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Address
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Phone number: Home/cell
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Special needs/allergies/Medical information/Other
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Emergency Contact(s) (Name/Phone)
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Home Church (if any)
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Additional Comments
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