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Vacation Bible School Registration Form
Please fill out the form below to participate in VBS this year! (One form per family please.)
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PARENT/GUARDIAN NAME(S):
*
Your answer
Street Address:
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone Number:
*
Your answer
Is this a cell phone?
*
Choose
Yes
No
Email Address:
*
Your answer
Number of children participating in Jerusalem Marketplace VBS:
*
Your answer
CHILD #1 REGISTRATION
Name:
*
Your answer
Age at time of VBS:
*
Your answer
Grade Entering:
*
Choose
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Gender
Male
Female
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CHILD #2 REGISTRATION
Leave blank if not applicable.
Name:
Your answer
Date of Birth:
MM
/
DD
/
YYYY
Grade Entering:
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Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Gender
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Female
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CHILD #3 REGISTRATION
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Name:
Your answer
Date of Birth:
MM
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DD
/
YYYY
Grade Entering:
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Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Gender
Male
Female
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CHILD #4 REGISTRATION
Leave blank if not applicable.
Name:
Your answer
Date of Birth:
MM
/
DD
/
YYYY
Grade Entering:
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Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Gender
Male
Female
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CHILD #5 REGISTRATION
Leave blank if not applicable.
Name:
Your answer
Date of Birth:
MM
/
DD
/
YYYY
Grade Entering:
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Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Gender
Male
Female
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