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VBS Registration 2021
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* Indicates required question
Child's Name
*
Your answer
Age
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Grade Completed
4 and 5 year olds
Kindergarten
1st and 2nd Grade
3rd and 4th Grade
5th and 6th Grade
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Parent's Name
*
Your answer
Parent Email
*
Your answer
Primary Phone Number
*
Your answer
Alternate Phone Number
Your answer
Do attend a local church?
*
Yes
No
If yes, what church?
Your answer
Who is authorized to pickup your child? (List up to 3 people, first and last name)
Parents please be prompt in dropping off at 6 and picking up at 8:30
Your answer
List any conditions or allergies of participant
Your answer
By checking this box I authorize that my child has permission to attend and participate from 6-8:30 PM in the Gateway Fellowship June 21-25, 2021 Vacation Bible School
*
I agree
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