Kaleidoscope VBS Registration

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Kaleidoscope VBS Registration

Kaleidoscope VBS Registration Form (The Fount, La Cima, VECFV)

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* Indicates required question

Email *

Your email

Child's First Name *

Your answer

Child's Last Name *

Your answer

Child's Age *

Your answer

Parent First Name *

Your answer

Parent Last Name *

Your answer

Parent Phone # *

Your answer

Parent E-Mail *

Your answer

Street Address *

Your answer

City *

Your answer

Zip Code *

Your answer

Regular Church Attender?

Yes

No

Clear selection

If so, which church?

Your answer

Emergency / Medical Info

Allergies or health concerns? *

No

Yes

If so please explain:

Your answer

Emergency Contact Name *

Your answer

Emergency Contact Phone # *

Your answer

Register another child? *

No

Yes

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