Vacation Bible School 2019

Child's name *

Parent's name(s) *

Parent phone number we can use to contact you while your child is in our care *

Emergency contact name *

Emergency contact phone number *

Allergies or other medical information that we should be aware of? *

Child's age/grade (if your child's grade/age isn't list, the class is full) *

Completed 1st Grade

Completed 2nd Grade

Completed 3rd Grade

Completed 4th Grade

Completed 5th Grade

Child's Birthday *

年

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月

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日