VBS 2017 Upward Bound Registration
Palmetto Hills Presbyterian Church
K4 - 5th grade (completed)
Child's First Name
Your answer
Child's Last Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Email Address
Your answer
Street Address
Street Address, City, State, ZIP Code
Your answer
School Grade will have completed by summer 2017 (children must have just completed grades K4-5th)
Your answer
Allergies
Your answer
Shirt size
Parent/Guardian full name
Your answer
Contact number
Your answer
Emergency contact name (different from Parent/Gaurdian)
Your answer
Emergency contact number (will only use if Parent/Gaurdian can not be reached)
Your answer
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