Vacation Bible School Registration
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Email *
Child's Name *
Grade Most Recently Completed
Child's Birthdate
MM
/
DD
/
YYYY
Parent/Guardian Name(s)
Home Address
Parent/Guardian Phone Number(s)
Names of People Authorized to Pick Up Child
Emergency Contact Name (not parent/guardian)
Emergency Contact Phone Number
List any allergies or medical concerns here:
Do you attend church anywhere?
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Do you have additional children to register for VBS?
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