RCC Vacation Bible School 2021 Registration  
Date: August 23-35 2021 (Monday - Wednesday) , 9:00 am-12:30 pm
Where: Riverside Community Church, 100 Gilbert Ave., Elmwood Park, NJ 07407

Questions?  Pastor Eunice: pastoreunice@riversidepeople.org 
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Child's Name *
Date of Birth *
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Child's age *
Last school grade completed *
Allergies, medical conditions, or special needs *
2nd Child's Name
Date of Birth
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Child's age
Last school grade completed
Allergies, medical conditions, or special needs
3rd Child's Name
Date of Birth
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Child's age
Last school grade completed
Allergies, medical conditions, or special needs
4th Child's Name
Date of Birth
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Child's age
Last school grade completed
Allergies, medical conditions, or special needs
Name of Parent(s)/Guardian(s) *
Cell Phone Number(s) *
Parent(s)/Guardian(s) email address *
Home Address (include street address, city, state, zip code) *
Name of Emergency Contact *
Emergency Contact Number *
Relationship to child *
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