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BREAKER ROCK BEACH - VBS 2024
Event Timing: May 30-June 1, @ 5:30pm - 8pm, Jun 2 @ 10:00am
Event Address: 3001 Meriwether, Shreveport, LA 71108
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Untitled Title
Breaker Rock Beach 2024
Parent/Guardian Name
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Your name
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Email
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Your e-mail
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Phone
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Child's Name
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Address
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(street address, city, state, and zip code)
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What days will you attend?
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Day 1
Day 2
Day 3
Day 4
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Date of Birth
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Date
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Emergency Contact(s)
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Include names and phone numbers other than listed above.
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Medical Information
Please list any medical or other information we need to know including any food allergies.
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Pick Up Info
Who may pick up your child at the end of each VBS day?
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Permission to Photograph Your Child for Promotion
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