Immanuel Church 2024 VBS Registration
July 29-August 2, 2024, 6-8:30 pm at 274 Columbia Turnpike Rensselaer
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Child's Name *
Address *
Birthdate *
MM
/
DD
/
YYYY
Gender *
School *
Grade Completed *
Does your child have any allergies, medical concerns, or is there any other information we should be aware of? *
Parent / Guardian's Name *
Contact Email *
Emergency Contact Phone Number *
Who can pick up your child? *
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