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VBS Registration - 4 years to 5th grade
Name of Child (First Name)
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Name of Child (Last Name)
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Parents Name (First and Last)
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Address (Line 1)
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City & State
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Zip
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Parent Email Address
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Parent Phone (For Emergency Only)
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Child's Age
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Child's Date of Birth
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Child's Grade (in the Fall)
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Child's Allergies and Health Concerns
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Name of Friend Your Child Would Like To Be Placed With
We will try to honor this request as we schedule the groups
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Name of Church Your Family Attends
Leave blank if you are currently not attending church
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Do you grant permission for your child's photo to be taken and potential posted on the church's website &/or Facebook.
Please check below if you do or do not want your child's photo to be taken by Park Hills Baptist Church.
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