VBS Registration Form
Please complete all of the information below.
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Child's Name: *
Birthdate *
MM
/
DD
/
YYYY
Gender: *
Grade most recently completed: *
Required
Mailing address: *
Parent/Guardian Name: *
Parent/Guardian Phone Number: *
Emergency Contact Name & Relationship to child *
Emergency Contact Phone Number *
Who may pick up your child? *
Name of church attended: *
Any known food allergies: *
Any known medical concerns *
Permission to use images and videos: I grant permission for Ebenezer Faith Bible Church to record sounds, images, or video of my child while attending this VBS program. I also give Ebenezer Faith Bible Church, at its sole discretion, to use these sounds, images, or videos in publications (including print, website, and social media platforms) owned by the Ebenezer Faith Bible Church. Please indicate:  *
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