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Child's First Name |
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Child'sLast Name |
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Age at Time of VBS |
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Birthday |
Grade Completed
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Parent's Names |
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Address |
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Home Phone |
Cell Phone
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Emergency Contact Person |
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Relationship to Student |
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Home Phone |
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Alternate Phone |
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List Food Allergies if Any. |
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List Medical Concerns if Any |
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Family Doctor |
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Doctor's Phone |
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Siblings Attending VBS |
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Church Affiliation |
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Church Membership at: |
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Brought By
& Picked Up By |
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Check all days your child(ren) plans to attend |
M
T
W
TH
F
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If you are interested in helping With VBS please mark yes |
Yes
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T- shirts are free
please indicate size
( 4T-5T, S, M,L,XL) |
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C-D available $5.00 |
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E-Mail Address |
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